Active NPI
Michelle M Madderom, D.C.
- Chiropractor
- Eagle River, WI
National Provider Identifier
1285915397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4753-12
- Practice address
- 761 US Highway 45 S
Eagle River, WI 54521-9110 - Phone
- (715) 479-8700
- NPI assigned
- Sep 1, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4753-12 | WI | Primary |
Addresses
Primary practice location
761 US Highway 45 S
Eagle River, WI 54521-9110
Mailing address
761 US Highway 45 S
Eagle River, WI 54521-9110
Phone (715) 479-8700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111130000453 | WI | Practitioner - Chiropractic | 8729252820 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eagle River Chiropractic SC
Practice addresses (Care Compare)
761 US Hwy 45 S
Eagle River, WI 54521-9110
Phone (715) 479-8870
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4753-12 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakes Chiropractic & Wellness SC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Eagle River, WI
- NPI 1609021856
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1314835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1285915397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "761 US HIGHWAY 45 S",
"city": "EAGLE RIVER",
"state": "WI",
"postal_code": "545219110",
"telephone_number": "715-479-8700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "761 US HIGHWAY 45 S",
"city": "EAGLE RIVER",
"state": "WI",
"postal_code": "545219110",
"telephone_number": "715-479-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDEROM",
"first_name": "MICHELLE",
"middle_name": "M",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-01",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "4753-12",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle River, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.