Individual provider Active NPI

Brent David Kowalke, D.C.

  • Chiropractor
  • Middleton, WI
National Provider Identifier
1356434526
Registry record updated Dec 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4240012 Issued in WI
Practice address
1468 N High Point Rd
Middleton, WI 53562-3683
Phone
(608) 833-7422
Fax
(608) 833-7421
NPI assigned
Oct 2, 2006
Last updated
Dec 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4240012 WI Primary

Addresses

Primary practice location

1468 N High Point Rd
Middleton, WI 53562-3683

Mailing address

1468 N High Point Rd
Middleton, WI 53562-3683
Phone (608) 833-7422

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070129000713 WI Practitioner - Chiropractic 5496756736 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4240012WIMDChiropractor

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419206400000",
    "number": "1356434526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1468 N HIGH POINT RD",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535623683",
            "telephone_number": "608-833-7422",
            "fax_number": "608-833-7421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1468 N HIGH POINT RD",
            "city": "MIDDLETON",
            "state": "WI",
            "postal_code": "535623683",
            "telephone_number": "608-833-7422",
            "fax_number": "608-833-7421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOWALKE",
        "first_name": "BRENT",
        "middle_name": "DAVID",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2014-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4240012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2014; 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.