Organization Active NPI

Sparta Chiropractic Clinic, LLC

  • Chiropractor
  • Sparta, WI
National Provider Identifier
1578747473
Registry record updated Jan 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3690 Issued in WI
Legal business name
SPARTA CHIROPRACTIC CLINIC, LLC
Practice address
110 W Wisconsin St
Sparta, WI 54656-2314
Phone
(608) 269-1451
Fax
(608) 269-1452
NPI assigned
Dec 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2008

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

Authorized official

Name
Dr. Cindy L Puent, DCNPI 1558361832
Title
Owner
Phone
(608) 269-1451

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3690 WI Primary

Addresses

Primary practice location

110 W Wisconsin St
Sparta, WI 54656-2314

Mailing address

110 W Wisconsin St
Sparta, WI 54656-2314
Phone (608) 269-1451

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080108000243 WI Part B Supplier - Clinic/Group Practice 2264512953 Receives reassigned benefits from 1 practitioner
Practice locations: Sparta, WI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D1085170Sparta Chiropractic Clinic LLC110 W Wisconsin St, Sparta, WI 54656Certificate of waiverJun 11, 2028

National Provider Directory

National Provider Directory

Locations

110 W Wisconsin St
Sparta, WI 54656
Phone (608) 269-1451

Practitioners & affiliated clinicians

Practitioners 1

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": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200528000000",
    "number": "1578747473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W WISCONSIN ST",
            "city": "SPARTA",
            "state": "WI",
            "postal_code": "546562314",
            "telephone_number": "608-269-1451",
            "fax_number": "608-269-1452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W WISCONSIN ST",
            "city": "SPARTA",
            "state": "WI",
            "postal_code": "546562314",
            "telephone_number": "608-269-1451",
            "fax_number": "608-269-1452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARTA CHIROPRACTIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2008-01-17",
        "status": "A",
        "authorized_official_last_name": "PUENT",
        "authorized_official_first_name": "CINDY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-269-1451",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sparta, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.