Individual provider Active NPI

Lee Charles Schwalenberg

  • Chiropractor
  • Kaukauna, WI
National Provider Identifier
1295947406
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4159-012 Issued in WI
Practice address
2450 Crooks Ave
Kaukauna, WI 54130-3914
Phone
(920) 462-0912
Fax
(920) 462-0914
NPI assigned
May 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4159-012 WI Primary

Addresses

Primary practice location

2450 Crooks Ave
Kaukauna, WI 54130-3914

Mailing address

2450 Crooks Ave
Kaukauna, WI 54130-3914
Phone (920) 462-0912

Other identifiers 1

IdentifierTypeStateIssuer
38963400MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051220000922 WI Practitioner - Chiropractic 9436170438 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stone Chiropractic LLCGroup PAC ID 0648291740, 2 clinicians

Practice addresses (Care Compare)

350 E Ann St
Kaukauna, WI 54130-3969
Phone (920) 462-0912

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4159-012WIMDChiropractor
4159WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Stone Chiropractic, LLC Chiropractor CurrentSince Nov 8, 2005 Accepting new patients

Locations

350 E Ann St
Kaukauna, WI 54130
Phone (920) 428-5556

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1295947406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 CROOKS AVE",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541303914",
            "telephone_number": "920-462-0912",
            "fax_number": "920-462-0914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 CROOKS AVE",
            "city": "KAUKAUNA",
            "state": "WI",
            "postal_code": "541303914",
            "telephone_number": "920-462-0912",
            "fax_number": "920-462-0914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHWALENBERG",
        "first_name": "LEE",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4159-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38963400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kaukauna, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.

Verify at the official NPI Registry.