Organization Active NPI

LP Chiropractic LLC

  • Chiropractor
  • Kenosha, WI
National Provider Identifier
1508072836
Registry record updated Aug 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
11N00000X Issued in WI
Legal business name
LP CHIROPRACTIC LLC
Practice address
5703 75TH St
Kenosha, WI 53142-3603
Phone
(262) 697-1363
Fax
(262) 697-1388
NPI assigned
May 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2011

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

Authorized official

Name
Robin Nelson
Title
Billing
Phone
(262) 697-1363

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 11N00000X WI Primary

Addresses

Primary practice location

5703 75TH St
Kenosha, WI 53142-3603

Mailing address

5703 75TH St
Kenosha, WI 53142-3603
Phone (262) 697-1363

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060117000266 WI Part B Supplier - Clinic/Group Practice 6709800816 Receives reassigned benefits from 2 practitioners
Practice locations: Kenosha, WI

National Provider Directory

National Provider Directory

Locations

5703 75th St
Kenosha, WI 53142
Phone (262) 697-1363

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312934400000",
    "number": "1508072836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5703 75TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423603",
            "telephone_number": "262-697-1363",
            "fax_number": "262-697-1388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5703 75TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531423603",
            "telephone_number": "262-697-1363",
            "fax_number": "262-697-1388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LP CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2011-08-10",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "262-697-1363"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "11N00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2011; 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.