Ethan A. Dull, D.C.
Individual provider Active NPI Rehabilitation Chiropractor · Pewaukee, WI
NPI 1699831909 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1699831909
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rehabilitation Chiropractor 111NR0400X
- License
- 3571 (WI)
- Practice address
- 2343 Silvernail Rd
Pewaukee, WI 53072-5402 - Phone
- (262) 542-4700
- Fax
- (262) 542-7499
- NPI assigned
- Dec 29, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Chiropractic Care Center-Waukesha,LLC
Practice addresses (Care Compare)
811 N Grandview Blvd
Suite a
Waukesha, WI 53188-2894
Phone (262) 542-9814
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040526000280 | WI | Practitioner - Chiropractic | 8426039488 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3571 | WI | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chiropractic Care Center-Waukesha,LLC | Current |
Accepting new patients | |
| Chiro-Med,SC | Rehabilitation | Past |
Accepting new patients |
Locations
811 N Grandview Blvd
Waukesha, WI 53188
Phone (262) 548-9999
811 N Grandview Blvd
Ste A
Waukesha, WI 53188
Phone (262) 542-9814
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | 3571 | WI | Yes |
Addresses
Primary practice location
2343 Silvernail Rd
Pewaukee, WI 53072-5402
Mailing address
12711 W Meadow LN
New Berlin, WI 53151-1831
Phone (262) 542-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 38922600 | Medicaid | WI |
Other providers in Pewaukee, WI
- James E Donaldson
- Angela Dorff
- Frances M Dossett
- Dr Christine Foskett LLC
- Ashley Duda
- Bobbi Jo Durst
- Britni Dworak
- Alyssa Coryne Dziondziak
- Lauren A Eckert
- Alicia Ehlen
All providers in Pewaukee, WI · Rehabilitation Chiropractor in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.