Active NPI
Scott M Theirl, D.C.
- Neurology Chiropractor
- Mequon, WI
National Provider Identifier
1649327784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Chiropractor
- License
- 4227-012
- Practice address
- 1009 W Glen Oaks LN
Suite 207
Mequon, WI 53092-3377 - Phone
- (800) 385-1655
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Chiropractor | 111NN0400X | #X009619 | NY | |
| Neurology Chiropractor | 111NN0400X | 4227-012 | WI | Primary |
Addresses
Primary practice location
1009 W Glen Oaks LN
Suite 207
Mequon, WI 53092-3377
Mailing address
333 Riverview Dr
Thiensville, WI 53092-1713
Phone (800) 385-1655
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| WI1690 | Other | WI | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100701000390 | WI | Practitioner - Chiropractic | 8820190317 | Practice locations: Mequon, WI |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #X009619 | NY | MD | Neurology Chiropractor |
| 4227-012 | WI | MD | Neurology Chiropractor |
| 009619 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1491264000000",
"number": "1649327784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 RIVERVIEW DR",
"city": "THIENSVILLE",
"state": "WI",
"postal_code": "530921713",
"telephone_number": "800-385-1655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1009 W GLEN OAKS LN",
"address_2": "SUITE 207",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923377",
"telephone_number": "800-385-1655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEIRL",
"first_name": "SCOTT",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2017-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "111NN0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Neurology",
"state": "NY",
"license": "#X009619",
"primary": false
},
{
"code": "111NN0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Neurology",
"state": "WI",
"license": "4227-012",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "WI1690",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2017; 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.