Wild Rivers Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

WILD RIVERS CHIROPRACTIC LLC

Practice address

1801 W Knapp St Ste 1
Rice Lake, WI 54868-1381

Phone

(715) 234-3067

Fax

(715) 234-3067

NPI assigned

Jun 25, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Jacob Jon Desantis, DCNPI 1952878415

Title

Owner

Phone

(715) 234-3067

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacob Jon Desantis

  • Chiropractor
  • Rice Lake, WI
  • NPI 1952878415
  Medicare reassignment Care Compare group NPD Authorized official
• Michaela Brynn Booth, DC

  • Chiropractor
  • Rice Lake, WI
  • NPI 1386506913
  Medicare reassignment Care Compare group NPD
• Kodye Joan Tangwall, DC

  • Chiropractor
  • Rice Lake, WI
  • NPI 1689480139
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776470400000",
    "number": "1649831132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 W JOHN ST STE 3",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548682918",
            "telephone_number": "715-234-3067",
            "fax_number": "715-234-3067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W KNAPP ST STE 1",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548681381",
            "telephone_number": "715-234-3067",
            "fax_number": "715-234-3067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILD RIVERS CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2026-04-18",
        "certification_date": "2026-04-18",
        "status": "A",
        "authorized_official_last_name": "DESANTIS",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-234-3067",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952878415",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Weich
• Susan Kay Weisenberger, OTR
• Elizabeth Lynn Wendt, RN
• Mark Steven Western, RPH
• Jennifer Why, OTR
• Shelly Renee Wildenberg, MS, RD, CD
• Wildsong Wellness
• Wildsong Wellness LLC
• Rebecca Williams
• David Bruce Wilson, D.D.S.

• Chiropractor in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2026; 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.