Alexander Anton Provost, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5599-12 Issued in WI

Practice address

W5675 County Road B
Shawano, WI 54166-6901

Phone

(715) 526-6158

NPI assigned

Jan 5, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, TX2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bad River Band of Lake Superior Tribe of Chippewa Indians Wis

  • Federally Qualified Health Center (FQHC)
  • Ashland, WI
  • NPI 1699701375

  TX

  Medicare reassignment Care Compare group NPD
• Countryview Chiropractic Clinic, S.C.

  • Chiropractor
  • Shawano, WI
  • NPI 1316095185
  Medicare reassignment NPD
• Bad River Band of Lake Superior Tribe of Chippewa Indians Wis.

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Ashland, WI
  • NPI 1780702829
  Care Compare group NPD
• Bad River Band of Lake Superior Tribe of Chippewa Indains Wis

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ashland, WI
  • NPI 1366618506
  NPD

Specialty

Chiropractic

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bad River Band of Lake Superior Tribe of Chippewa Indians Wis 15 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1306434337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8732 POLK ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554342346",
            "telephone_number": "763-439-6576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W5675 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541666901",
            "telephone_number": "715-526-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVOST",
        "first_name": "ALEXANDER",
        "middle_name": "ANTON",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6646",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5599-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony W Phillips, M.D.
• Anton A Piantek, D.D.S.
• Margaret L Pieper, CD
• Katrina Marie Pierson
• Tracy Porath, BSW
• Amber-Ann Alicia Quaintance, NP
• Kathleen Qualheim, MD
• Ralph H Horsens DDS SC
• Jean A Ranta, PT
• Tina Marie Ready, PTA

• All providers in Shawano, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; 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.