Elk Mound Chiropractic LLC
Organization Active NPI Chiropractor · Elk Mound, WI
NPI 1528290798 · NPPES record last updated Aug 20, 2009
Key facts
- NPI
- 1528290798
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4513-012 (WI)
- Legal business name
- ELK MOUND CHIROPRACTIC LLC
- Practice address
- 205 W Menomonie St
Elk Mound, WI 54739-9520 - Phone
- (715) 879-4480
- Fax
- (715) 879-4490
- NPI assigned
- Aug 20, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Edward Paul Rygiel, D.C.
- Title
- Provider/Owner
- Phone
- (715) 879-4480
Practitioners 1
-
Edward Paul Rygiel, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090917000668 | WI | Part B Supplier - Clinic/Group Practice | 6608922513 |
Receives reassigned benefits from 1 practitioner Practice locations: Elk Mound, WI |
National Provider Directory
Locations
205 W Menomonie St
Elk Mound, WI 54739
Phone (715) 879-4480
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 4513-012 | WI | Yes |
Addresses
Primary practice location
205 W Menomonie St
Elk Mound, WI 54739-9520
Mailing address
205 W Menomonie St
Elk Mound, WI 54739-9520
Phone (715) 879-4480
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063640662 | Medicaid | WI |
Other providers in Elk Mound, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2009. 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.