Organization Active NPI

Krieser Family Chiropractic, LLC

  • Chiropractor
  • Nashotah, WI
National Provider Identifier
1417092909
Registry record updated Sep 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4167-012 Issued in WI
Legal business name
KRIESER FAMILY CHIROPRACTIC, LLC
Practice address
W330N4339 Lakeland Dr
Nashotah, WI 53058-9798
Phone
(262) 563-1000
Fax
(262) 563-1200
NPI assigned
Feb 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2013

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

Authorized official

Name
Dr. Kenneth J Krieser, DCNPI 1013973155
Title
Owner
Phone
(262) 563-1000

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 4167-012 WI Primary

Addresses

Primary practice location

W330N4339 Lakeland Dr
Nashotah, WI 53058-9798

Mailing address

W330N4339 Lakeland Dr
Nashotah, WI 53058-9798
Phone (262) 563-1000

Other identifiers 1

IdentifierTypeStateIssuer
38967400MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060302000542 WI Part B Supplier - Clinic/Group Practice 5193731958 Receives reassigned benefits from 1 practitioner
Practice locations: Nashotah, WI

National Provider Directory

National Provider Directory

Locations

1280 Brown St
Ste F
Oconomowoc, WI 53066
Phone (262) 567-6700

Practitioners & affiliated clinicians

Practitioners 5

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": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379548800000",
    "number": "1417092909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W330N4339 LAKELAND DR",
            "city": "NASHOTAH",
            "state": "WI",
            "postal_code": "530589798",
            "telephone_number": "262-563-1000",
            "fax_number": "262-563-1200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W330N4339 LAKELAND DR",
            "city": "NASHOTAH",
            "state": "WI",
            "postal_code": "530589798",
            "telephone_number": "262-563-1000",
            "fax_number": "262-563-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KRIESER FAMILY CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2013-09-19",
        "status": "A",
        "authorized_official_last_name": "KRIESER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-563-1000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4167-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38967400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashotah, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2013; 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.