Individual provider Active NPI

Jeffrey L Walters, D.C.

  • Chiropractor
  • Fond Du Lac, WI
National Provider Identifier
1699753517
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2820 Issued in WI
Practice address
97 S Pioneer Rd
Suite 100
Fond Du Lac, WI 54935-3873
Phone
(920) 924-9600
Fax
(920) 924-9360
NPI assigned
Jan 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2820 WI Primary

Addresses

Primary practice location

97 S Pioneer Rd
Suite 100
Fond Du Lac, WI 54935-3873

Mailing address

97 S Pioneer Rd
Suite 100
Fond Du Lac, WI 54935-3873
Phone (920) 924-9600

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101008000240 WI Practitioner - Chiropractic 0749249134 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - Davenport, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

97 S Pioneer Rd
Suite 100
Fond Du Lac, WI 54935-3803
Phone (920) 924-9600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Preferred Chiropractic, SC Chiropractor CurrentSince Jan 1, 1999 Accepting new patients

Locations

97 S Pioneer Rd
Ste 100
Fond du Lac, WI 54935
Phone (920) 924-9600

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1699753517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 S PIONEER RD",
            "address_2": "SUITE 100",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353873",
            "telephone_number": "920-924-9600",
            "fax_number": "920-924-9360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 S PIONEER RD",
            "address_2": "SUITE 100",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353873",
            "telephone_number": "920-924-9600",
            "fax_number": "920-924-9360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "JEFFREY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.