NPIMap

Individual provider Active NPI

Gregory L Bonikowske, DC

  • Chiropractor
  • Wauwatosa, WI
National Provider Identifier
1700116233
Registry record updated May 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4606-012 Issued in WI
Practice address
2323 N Mayfair Rd
Suite 104
Wauwatosa, WI 53226-1506
Phone
(414) 837-4468
Fax
(414) 837-4212
NPI assigned
Jan 6, 2010
Last updated
May 19, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4606-012 WI Primary

Addresses

Primary practice location

2323 N Mayfair Rd
Suite 104
Wauwatosa, WI 53226-1506

Mailing address

2323 N Mayfair Rd
Suite 104
Wauwatosa, WI 53226-1506
Phone (414) 837-4468

Other identifiers 1

IdentifierTypeStateIssuer
4606-012OtherWIWI DEPARTMENT OF REGULATION AND LICENSING

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4606-012WIMDChiropractor
5306MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Waupaca Chiropractic Center, Inc Chiropractor PastSince Apr 1, 2003 Accepting new patients
Tell Peck Chiropractic Inc Chiropractor Past Accepting new patients
Wissota Chiropractic Chiropractor PastSince Oct 15, 2014 Accepting new patients
Kromrey Chiropractic, S.C. Chiropractor PastSince Jan 1, 2005 Accepting new patients
Belde Chiropractic Clinic, PA Chiropractor PastSince Nov 1, 2012 Accepting new patients
IHS Midwest PC Chiropractor PastSince Mar 1, 2011 Accepting new patients
Raschke Chiropractic Center SC Chiropractor PastSince Apr 29, 2011 Accepting new patients

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1262736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1431993600000",
    "number": "1700116233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2323 N MAYFAIR RD",
            "address_2": "SUITE 104",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261506",
            "telephone_number": "414-837-4468",
            "fax_number": "414-837-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2323 N MAYFAIR RD",
            "address_2": "SUITE 104",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532261506",
            "telephone_number": "414-837-4468",
            "fax_number": "414-837-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONIKOWSKE",
        "first_name": "GREGORY",
        "middle_name": "L",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-06",
        "last_updated": "2015-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4606-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI DEPARTMENT OF REGULATION AND LICENSING",
            "identifier": "4606-012",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.