NPIMap

Organization Active NPI

Sports & Family Chiropractic LLC

  • Chiropractor
  • Kenosha, WI
National Provider Identifier
1578889242
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4598-012 Issued in WI
Legal business name
SPORTS & FAMILY CHIROPRACTIC LLC
Practice address
6123 Green Bay Road
Ste 140
Kenosha, WI 53142
Phone
(262) 653-9208
NPI assigned
Apr 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

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

Authorized official

Name
Dr. Hae Yong Chung, D.C
Title
President
Phone
(262) 653-9208

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 4600-012 WI
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 4598-012 WI Primary

Addresses

Primary practice location

6123 Green Bay Road
Ste 140
Kenosha, WI 53142

Mailing address

6123 Green Bay Road
Ste 140
Kenosha, WI 53142
Phone (262) 653-9208

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110210001051 WI Part B Supplier - Clinic/Group Practice 6103006986 Receives reassigned benefits from 2 practitioners
Practice locations: Kenosha, WI

National Provider Directory

National Provider Directory

Locations

6123 Green Bay Rd
Ste 140
Kenosha, WI 53142
Phone (262) 358-4459

6123 Green Bay Rd
Ste 120B
Kenosha, WI 53142
Phone (262) 653-9208

Practitioners & affiliated clinicians

Practitioners 2

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": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1578889242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY ROAD",
            "address_2": "STE 140",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53142",
            "telephone_number": "262-653-9208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY ROAD",
            "address_2": "STE 140",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "53142",
            "telephone_number": "262-653-9208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS & FAMILY CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "HAE YONG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-653-9208",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4600-012",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4598-012",
            "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 Jan 20, 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.