NPIMap

Organization Active NPI

Riversedge Chiropractic, LLC

Doing business as Paull Chiropractic at Riversedge

  • Sports Physician Chiropractor
  • Janesville, WI
National Provider Identifier
1285058966
Registry record updated Feb 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
4035-012 Issued in WI
Legal business name
RIVERSEDGE CHIROPRACTIC, LLC
Doing business as
Paull Chiropractic at Riversedge
Practice address
111 N Main St
Suite 100
Janesville, WI 53545-3096
Phone
(608) 754-8977
Fax
(608) 754-8979
NPI assigned
Feb 14, 2014
Last updated
Feb 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Andrew Paull, DC, CCSPNPI 1437116068
Title
Owner/ Chiropractor
Phone
(608) 754-8977

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 4035-012 WI Primary

Addresses

Primary practice location

111 N Main St
Suite 100
Janesville, WI 53545-3096

Mailing address

111 N Main St
Suite 100
Janesville, WI 53545-3096
Phone (608) 754-8977

Other names 1

  • Paull Chiropractic at Riversedge Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140307000297 WI Part B Supplier - Clinic/Group Practice 7618107830 Receives reassigned benefits from 3 practitioners
Practice locations: Janesville, WI

National Provider Directory

National Provider Directory

Locations

100 W Racine St
Janesville, WI 53548
Phone (608) 751-0955

111 N Main St
Ste 100
Janesville, WI 53545
Phone (608) 580-0031

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392336000000",
    "number": "1285058966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MAIN ST",
            "address_2": "SUITE 100",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535453096",
            "telephone_number": "608-754-8977",
            "fax_number": "608-754-8979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MAIN ST",
            "address_2": "SUITE 100",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535453096",
            "telephone_number": "608-754-8977",
            "fax_number": "608-754-8979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSEDGE CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-14",
        "last_updated": "2014-02-14",
        "status": "A",
        "authorized_official_last_name": "PAULL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER/ CHIROPRACTOR",
        "authorized_official_telephone_number": "608-754-8977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC, CCSP"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "WI",
            "license": "4035-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paull Chiropractic at Riversedge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Janesville, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.