Connor David Keating, D.C.
Individual provider Active NPI Chiropractor · Sullivan, WI
NPI 1689209694 · NPPES record last updated Mar 9, 2024
Key facts
- NPI
- 1689209694
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5526-12 (WI)
- Practice address
- 148 Main St
Sullivan, WI 53178-9665 - Phone
- (262) 582-3077
- NPI assigned
- Mar 10, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
148 Main St
Sullivan, WI 53178-9665
Phone (262) 582-3077
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200324001683 | WI | Practitioner - Chiropractic | 7416385596 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5526-12 | WI | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Encompass Chiropractic LLC | Current |
Accepting new patients |
Locations
148 Main St
Sullivan, WI 53178
Phone (262) 582-3077
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5526-12 | WI | Yes |
Addresses
Primary practice location
148 Main St
Sullivan, WI 53178-9665
Mailing address
148 Main St
Sullivan, WI 53178-9665
Phone (262) 582-3077
Other providers in Sullivan, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.