Active NPI
Roy W Mutsch, D.C.
- Orthopedic Chiropractor
- Brown Deer, WI
National Provider Identifier
1528118635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Chiropractor
- License
- 1651
- Practice address
- 4680 W Bradley Rd
Brown Deer, WI 53223-3764 - Phone
- (414) 355-7690
- Fax
- (414) 355-7672
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Chiropractor | 111NX0800X | 1651 | WI | Primary |
Addresses
Primary practice location
4680 W Bradley Rd
Brown Deer, WI 53223-3764
Mailing address
W71N918 Harrison CT
Cedarburg, WI 53012-3234
Phone (262) 375-4776
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38908100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3172 | MA | MD | Mental Health Counselor |
| 1651 | WI | MD | Orthopedic Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cerasuolo Enterprises, Inc | Past | Accepting new patients | |
| Chiropractic Care Centers, Inc | Past | Accepting new patients | |
| Chiropractic Care Center, LLC | Past | Accepting new patients | |
| Di Metz, LLC | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
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- NPI 1023203163
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- Chiropractor
- Fitchburg, MA
- NPI 1568612547
-
- Physical Therapist
- Lowell, MA
- NPI 1144473133
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528118635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W71N918 HARRISON CT",
"city": "CEDARBURG",
"state": "WI",
"postal_code": "530123234",
"telephone_number": "262-375-4776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4680 W BRADLEY RD",
"city": "BROWN DEER",
"state": "WI",
"postal_code": "532233764",
"telephone_number": "414-355-7690",
"fax_number": "414-355-7672"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUTSCH",
"first_name": "ROY",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NX0800X",
"taxonomy_group": "",
"desc": "Chiropractor, Orthopedic",
"state": "WI",
"license": "1651",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "38908100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brown Deer, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.