NPIMap

Organization Active NPI

The Chiropractic Advantage LLC

  • Chiropractor
  • Appleton, WI
National Provider Identifier
1336420751
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4790-012 Issued in WI
Legal business name
THE CHIROPRACTIC ADVANTAGE LLC
Practice address
645 W Ridgeview Dr
Appleton, WI 54911-1254
Phone
(920) 997-9740
Fax
(920) 997-9748
NPI assigned
Aug 30, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Authorized official

Name
Dr. Tyler Skibba, D.C., C.C.E.P.NPI 1629359120
Title
Chiropractor, Member
Phone
(715) 323-0389

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4790-012 WI Primary

Addresses

Primary practice location

645 W Ridgeview Dr
Appleton, WI 54911-1254

Mailing address

645 W Ridgeview Dr
Appleton, WI 54911-1254
Phone (920) 997-9740

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111024000617 WI Part B Supplier - Clinic/Group Practice 9537233531 Receives reassigned benefits from 9 practitioners
Practice locations: Appleton, WI

National Provider Directory

National Provider Directory

Locations

658 W Ridgeview Dr
Appleton, WI 54911
Phone (920) 997-9740

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1336420751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 W RIDGEVIEW DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549111254",
            "telephone_number": "920-997-9740",
            "fax_number": "920-997-9748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 W RIDGEVIEW DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549111254",
            "telephone_number": "920-997-9740",
            "fax_number": "920-997-9748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHIROPRACTIC ADVANTAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "SKIBBA",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CHIROPRACTOR, MEMBER",
        "authorized_official_telephone_number": "715-323-0389",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., C.C.E.P."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4790-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.