Active NPI
Ethan A. Dull, D.C.
- Rehabilitation Chiropractor
- Pewaukee, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Chiropractor
- License
- 3571
- Practice address
- 2343 Silvernail Rd
Pewaukee, WI 53072-5402 - Phone
- (262) 542-4700
- Fax
- (262) 542-7499
- NPI assigned
- Dec 29, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Chiropractor | 111NR0400X | 3571 | WI | Primary |
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
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- National College of Chiropractic, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
811 N Grandview Blvd
Suite a
Waukesha, WI 53188-2894
Phone (262) 542-9814
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Greendale, WI
- NPI 1063693166
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699831909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12711 W MEADOW LN",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "531511831",
"telephone_number": "262-542-4700",
"fax_number": "262-542-7499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2343 SILVERNAIL RD",
"city": "PEWAUKEE",
"state": "WI",
"postal_code": "530725402",
"telephone_number": "262-542-4700",
"fax_number": "262-542-7499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DULL",
"first_name": "ETHAN",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": "WI",
"license": "3571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pewaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.