Appleton Wellness Way LLC
Organization Active NPI Chiropractor · Kimberly, WI
NPI 1376908061 · NPPES record last updated Feb 22, 2016
Key facts
- NPI
- 1376908061
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4405-012 (WI)
- Legal business name
- APPLETON WELLNESS WAY LLC
- Practice address
- 1037 Truman St
Suite B
Kimberly, WI 54136-2217 - Phone
- (920) 733-3371
- NPI assigned
- Dec 22, 2015
- Organization subpart
- No
Authorized official
- Name
- Patrick Flynn
- Title
- Member
- Phone
- (920) 733-3371
Practitioners 10
-
Jesse Anderson, DC
-
Jennifer T Mauel, D.C.
-
Patrick Michael Flynn, D.C.
-
Andrew Chater Judkins, D.C.
-
Kenneth E Munson, DC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160317000154 | WI | Part B Supplier - Clinic/Group Practice | 2860798808 |
Receives reassigned benefits from 5 practitioners Practice locations: Appleton, WI |
National Provider Directory
Locations
2021 S Oneida St
Appleton, WI 54915
Phone (920) 733-3371
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4405-012 | WI | Yes |
Addresses
Primary practice location
1037 Truman St
Suite B
Kimberly, WI 54136-2217
Mailing address
1037 Truman St
Suite B
Kimberly, WI 54136-2217
Other providers in Kimberly, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.