Lake Delton Chiropractic Clinic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4029-012 Issued in WI

Legal business name

LAKE DELTON CHIROPRACTIC CLINIC LLC

Doing business as

HealthSource Chiropractic & Progressive Wellness

Practice address

151 Wisconsin Dells Pkwy S
Wisconsin Dells, WI 53965

Phone

(608) 253-0102

Fax

(608) 253-0188

NPI assigned

Aug 30, 2006

Last updated

May 17, 2019By 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. Todd Joseph Bauer, D.C.NPI 1609981380

Title

Owner

Phone

(608) 697-9994

Specialties & licenses 1

Addresses

Other names 1

• HealthSource Chiropractic & Progressive Wellness Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 1

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.

• Todd Joseph Bauer, D.C.

  • Chiropractor
  • Wisconsin Dells, WI
  • NPI 1609981380
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558051200000",
    "number": "1619087871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 WISCONSIN DELLS PKWY S",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "53965",
            "telephone_number": "608-253-0102",
            "fax_number": "608-253-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "151 WISCONSIN DELLS PKWY S",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "53965",
            "telephone_number": "608-253-0102",
            "fax_number": "608-253-0188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE DELTON CHIROPRACTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2019-05-17",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "608-697-9994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4029-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource Chiropractic & Progressive Wellness",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HealthSource Chiropractic & Progressive Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Edward Joseph, D.C.
• Robert Ryan Kaas
• Kimberly A Kelly, P.T.
• Daryl Francis Kemna, R.PH
• Cheryl Lynn Kolf, MS-MHC, MED, LPC
• Tamara Marie Laskowski, LCSW
• Britney Ann Leege, PTA
• Betsy Ann Long, D.D.S.
• Megan Long, M.S.
• Karin Lyn Luther, PT

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; 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.