NPIMap

Organization Active NPI

Waupun Chiropractic Center, S.C.

  • Chiropractor
  • Waupun, WI
National Provider Identifier
1467676338
Registry record updated Feb 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2757-012 Issued in WI
Legal business name
WAUPUN CHIROPRACTIC CENTER, S.C.
Practice address
160 Gateway Dr
Waupun, WI 53963-2276
Phone
(920) 324-9899
Fax
(920) 324-9898
NPI assigned
Apr 12, 2007
Last updated
Feb 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2018

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

Authorized official

Name
Randall L Blohowiak, D.C.
Title
Owner
Phone
(920) 324-9899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2757-012 WI Primary

Addresses

Primary practice location

160 Gateway Dr
Waupun, WI 53963-2276

Mailing address

160 Gateway Dr
Waupun, WI 53963-2276
Phone (920) 324-9899

Other identifiers 2

IdentifierTypeStateIssuer
38955100MedicaidWI
38861600MedicaidWI

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519776000000",
    "number": "1467676338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 GATEWAY DR",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632276",
            "telephone_number": "920-324-9899",
            "fax_number": "920-324-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 GATEWAY DR",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632276",
            "telephone_number": "920-324-9899",
            "fax_number": "920-324-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUPUN CHIROPRACTIC CENTER, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2018-02-28",
        "status": "A",
        "authorized_official_last_name": "BLOHOWIAK",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-324-9899",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2757-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38955100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38861600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupun, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.