Dietrich Chiropractic, SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3621-012 Issued in WI

Legal business name

DIETRICH CHIROPRACTIC, SC

Practice address

1105 W Grand Ave
Wisconsin Rapids, WI 54495-3349

Phone

(715) 423-4050

Fax

(715) 424-3108

NPI assigned

Oct 31, 2007

Last updated

Oct 31, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. John B. Dietirch II, DC

Title

President

Phone

(715) 423-4050

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John B. Dietrich II, DC

  • Chiropractor
  • Wisconsin Rapids, WI
  • NPI 1477607307
  Medicare reassignment NPD
• Robert William Sazama, D.C.

  • Chiropractor
  • Mesa, AZ
  • NPI 1447407119
  NPD (past)

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193788800000",
    "number": "1568641116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W GRAND AVE",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544953349",
            "telephone_number": "715-423-4050",
            "fax_number": "715-424-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 W GRAND AVE",
            "city": "WISCONSIN RAPIDS",
            "state": "WI",
            "postal_code": "544953349",
            "telephone_number": "715-423-4050",
            "fax_number": "715-424-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIETRICH CHIROPRACTIC, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-31",
        "last_updated": "2007-10-31",
        "status": "A",
        "authorized_official_last_name": "DIETIRCH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-423-4050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3621-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Nichole Derrie, BCBA
• Sarah Derringer
• Makena Lizabeth Detlor, LPC-IT
• Tina Diaz
• Scott E Dickman, MD
• John B. Dietrich II, DC
• Marissa Nicole Dobratz, RN
• Mary Elizabeth Doolittle, DDS
• Rebecca Dorshorst, CFA
• Michael J Downs, OD

• Chiropractor in Wisconsin Rapids, WI
• Providers in Wisconsin Rapids, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; 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.