Northern Chiropractic and Wellness LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5160-12 Issued in WI

Legal business name

NORTHERN CHIROPRACTIC AND WELLNESS LLC

Practice address

709 Dyer St
Crivitz, WI 54114-7480

Phone

(715) 854-5025

NPI assigned

Oct 13, 2016

Last updated

Oct 13, 2016By 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. Kellen J. Blanck-Grott, D.C.NPI 1306200472

Title

Owner/Doctor of Chiropractic

Phone

(715) 854-5025

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

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.

• Kellen Blanck-Grott, D.C.

  • Chiropractor
  • Crivitz, WI
  • NPI 1306200472
  Medicare reassignment NPD Authorized official
• Brianna Blanck-Grott, D.C.

  • Chiropractor
  • Crivitz, WI
  • NPI 1831587633
  NPD (past)

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

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476316800000",
    "number": "1619427630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 593",
            "city": "CRIVITZ",
            "state": "WI",
            "postal_code": "541140593",
            "telephone_number": "715-854-5025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 DYER ST",
            "city": "CRIVITZ",
            "state": "WI",
            "postal_code": "541147480",
            "telephone_number": "715-854-5025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN CHIROPRACTIC AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-13",
        "last_updated": "2016-10-13",
        "status": "A",
        "authorized_official_last_name": "BLANCK-GROTT",
        "authorized_official_first_name": "KELLEN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER/DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "715-854-5025",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5160-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Nelsen
• New Care, Inc. (NEWCare Convalescent Center)
• Newcare Inc (NEWCare Therapy Service)
• Melissa Newingham
• Anisha Niskanen, RN
• Northreach Healthcare, LLC (Crivitz Medical Center)
• Oconto Hospital & Medical Center, Inc. (Bellin Health Crivitz)
• Chassie Le Olson, LPTA
• Anna Rae Pelner, PTA
• Kevin J Pepin, DDS

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2016; 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.