Advanced Spine Center, S.C.
Organization Active NPI Chiropractor · Mequon, WI
NPI 1497290761 · NPPES record last updated Dec 22, 2016
Key facts
- NPI
- 1497290761
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4239-012 (WI)
- Legal business name
- ADVANCED SPINE CENTER, S.C.
- Practice address
- 11203 N Buntrock Ave
100
Mequon, WI 53092-1857 - Phone
- (262) 512-1661
- Fax
- (262) 512-1663
- NPI assigned
- Dec 22, 2016
- Organization subpart
- No
Authorized official
- Name
- Molly Hausmann, D.C.
- Title
- Owner/Chiropractor
- Phone
- (262) 512-1661
Practitioners 2
-
Molly S Hausmann, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161230001258 | WI | Part B Supplier - Clinic/Group Practice | 8426338062 |
Receives reassigned benefits from 1 practitioner Practice locations: Mequon, WI |
National Provider Directory
Locations
11203 N Buntrock Ave
Ste 100
Mequon, WI 53092
Phone (262) 512-1661
11203 N Buntrock Ave
#100
Mequon, WI 53092
Phone (262) 512-1661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4239-012 | WI | Yes |
Addresses
Primary practice location
11203 N Buntrock Ave
100
Mequon, WI 53092-1857
Mailing address
11203 N Buntrock Ave
100
Mequon, WI 53092-1857
Phone (262) 512-1661
Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 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.