NPIMap

Organization Active NPI

One Source Wellness and Chiropractic LLC

Doing business as One Source Wellness and Chiropractic

  • Chiropractor
  • Brookfield, WI
National Provider Identifier
1710341847
Registry record updated Mar 11, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3958-12 Issued in WI
Legal business name
ONE SOURCE WELLNESS AND CHIROPRACTIC LLC
Doing business as
One Source Wellness and Chiropractic
Practice address
13730 W Greenfield Ave
Brookfield, WI 53005-7115
Phone
(262) 751-7505
NPI assigned
Apr 5, 2016
Last updated
Mar 11, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2020

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

Authorized official

Name
Mr. Paul Edward Ralston, DCNPI 1003955873
Title
DC
Phone
(262) 751-7505

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3958-12 WI Primary

Addresses

Primary practice location

13730 W Greenfield Ave
Brookfield, WI 53005-7115

Mailing address

13730 W Greenfield Ave
Brookfield, WI 53005-7115
Phone (262) 751-7505

Other identifiers 2

IdentifierTypeStateIssuer
111N00000XOtherWITAXONOMY CHIROPRACTOR
38947700MedicaidWI

Other names 1

  • ONE SOURCE WELLNESS AND CHIROPRACTIC Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1459814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583884800000",
    "number": "1710341847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13730 W GREENFIELD AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530057115",
            "telephone_number": "262-751-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13730 W GREENFIELD AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530057115",
            "telephone_number": "262-751-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE SOURCE WELLNESS AND CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-05",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A",
        "authorized_official_last_name": "RALSTON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "DC",
        "authorized_official_telephone_number": "262-751-7505",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3958-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY CHIROPRACTOR",
            "identifier": "111N00000X",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38947700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ONE SOURCE WELLNESS AND CHIROPRACTIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ONE SOURCE WELLNESS AND CHIROPRACTIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brookfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2020; 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.