Organization Active NPI

Lutz Chiropractic SC

  • Chiropractor
  • West Bend, WI
National Provider Identifier
1407917388
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
LUTZ CHIROPRACTIC SC
Practice address
2150 Chestnut Street
West Bend, WI 53095-2908
Phone
(262) 334-5431
Fax
(262) 335-6481
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jeffrey Joseph Lutz, DCNPI 1063573947
Title
Vice President
Phone
(262) 334-5431

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: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

2150 Chestnut Street
West Bend, WI 53095-2908

Mailing address

2150 Chestnut Street
West Bend, WI 53095-2908
Phone (262) 334-5431

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071105000236 WI Part B Supplier - Clinic/Group Practice 2062509227 Receives reassigned benefits from 3 practitioners
Practice locations: West Bend, WI

National Provider Directory

National Provider Directory

Locations

2150 Chestnut St
West Bend, WI 53095
Phone (262) 334-5431

Practitioners & affiliated clinicians

Practitioners 3

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": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407917388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 CHESTNUT STREET",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952908",
            "telephone_number": "262-334-5431",
            "fax_number": "262-335-6481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 CHESTNUT STREET",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952908",
            "telephone_number": "262-334-5431",
            "fax_number": "262-335-6481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTZ CHIROPRACTIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUTZ",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "262-334-5431",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

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