Mac Kozaczuk, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6159-12 Issued in WI

Practice address

S71W23325 National Ave Ste 5
Big Bend, WI 53103-9495

Phone

(262) 662-9775

Fax

(262) 662-9773

NPI assigned

Jan 25, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Big Bend Vernon Releif & Wellness SC

  • Chiropractor
  • Big Bend, WI
  • NPI 1871743047
  NPD

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

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1306608294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S71W23325 NATIONAL AVE STE 5",
            "city": "BIG BEND",
            "state": "WI",
            "postal_code": "531039495",
            "telephone_number": "262-662-9775",
            "fax_number": "262-662-9773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S71W23325 NATIONAL AVE STE 5",
            "city": "BIG BEND",
            "state": "WI",
            "postal_code": "531039495",
            "telephone_number": "262-662-9775",
            "fax_number": "262-662-9773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOZACZUK",
        "first_name": "MAC",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "6159-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Big Bend, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.