NPIMap

Organization Active NPI

Appleton Wellness Way LLC

  • Chiropractor
  • Kimberly, WI
National Provider Identifier
1376908061
Registry record updated Feb 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4405-012 Issued in 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
Last updated
Feb 22, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2016

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

Authorized official

Name
Patrick FlynnNPI 1366477341
Title
Member
Phone
(920) 733-3371

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 4405-012 WI Primary

Addresses

Primary practice location

1037 Truman St
Suite B
Kimberly, WI 54136-2217

Mailing address

1037 Truman St
Suite B
Kimberly, WI 54136-2217

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160317000154 WI Part B Supplier - Clinic/Group Practice 2860798808 Receives reassigned benefits from 5 practitioners
Practice locations: Appleton, WI

National Provider Directory

National Provider Directory

Locations

1037 Truman St
Ste B
Kimberly, WI 54136
Phone (920) 733-3371

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1450742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456099200000",
    "number": "1376908061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1037 TRUMAN ST",
            "address_2": "SUITE B",
            "city": "KIMBERLY",
            "state": "WI",
            "postal_code": "541362217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1037 TRUMAN ST",
            "address_2": "SUITE B",
            "city": "KIMBERLY",
            "state": "WI",
            "postal_code": "541362217",
            "telephone_number": "920-733-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLETON WELLNESS WAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-22",
        "last_updated": "2016-02-22",
        "status": "A",
        "authorized_official_last_name": "FLYNN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "920-733-3371"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4405-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kimberly, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; 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.