NPIMap

Organization Active NPI

Chiropractic Associatess of Kenosha a S C

  • Clinic/Center
  • Kenosha, WI
National Provider Identifier
1699079079
Registry record updated Mar 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
3665 Issued in WI
Legal business name
CHIROPRACTIC ASSOCIATESS OF KENOSHA A S C
Practice address
3120 80TH St
Kenosha, WI 53142-4946
Phone
(262) 942-9955
Fax
(262) 942-9958
NPI assigned
Dec 29, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2011

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

Authorized official

Name
Dr. Michael Trabbold, D.C., CCSPNPI 1649369828
Title
Owner/President
Phone
(262) 942-9955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 3665 WI Primary

Addresses

Primary practice location

3120 80TH St
Kenosha, WI 53142-4946

Mailing address

3120 80TH St
Kenosha, WI 53142-4946
Phone (262) 942-9955

Other identifiers 1

IdentifierTypeStateIssuer
38928300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110216000571 WI Part B Supplier - Clinic/Group Practice 4082895586 Receives reassigned benefits from 1 practitioner
Practice locations: Kenosha, WI; Muskego, WI

National Provider Directory

National Provider Directory
Tax ID family
Chiropractic Associates of Kenosha SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5908 39th Ave
Kenosha, WI 53144
Phone (262) 657-8082

S69W15689 Janesville Rd
Muskego, WI 53150
Phone (414) 422-1203

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1293580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300924800000",
    "number": "1699079079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 80TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424946",
            "telephone_number": "262-942-9955",
            "fax_number": "262-942-9958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3120 80TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531424946",
            "telephone_number": "262-942-9955",
            "fax_number": "262-942-9958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC ASSOCIATESS OF KENOSHA A S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-29",
        "last_updated": "2011-03-24",
        "status": "A",
        "authorized_official_last_name": "TRABBOLD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "262-942-9955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C., CCSP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "3665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38928300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; 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.