Individual provider Active NPI

Corey M Sandquist, DC

  • Chiropractor
  • Wausau, WI
National Provider Identifier
1730285701
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2345-012 Issued in WI
Practice address
1202 Grand Ave
Wausau, WI 54403-6690
Phone
(715) 842-7711
NPI assigned
Sep 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2345-012 WI Primary

Addresses

Primary practice location

1202 Grand Ave
Wausau, WI 54403-6690

Mailing address

601 S 32ND Ave
Wausau, WI 54401-3958
Phone (715) 848-2526

Other identifiers 4

IdentifierTypeStateIssuer
38838500MedicaidWI
350041604OtherWIRAILROAD MEDICARE
26525OtherSECURITY HEALTH PLAN
38987500OtherWIMEDICAID GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101019001370 WI Practitioner - Chiropractic 9436342755 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1202 Grand Ave
Wausau, WI 54403-6690
Phone (715) 842-7711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2345-012WIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Allied Health of Wisconsin, SC Chiropractor CurrentSince Sep 30, 1994 Accepting new patients
Sandquist Chiropractic, Inc Chiropractor CurrentSince Dec 31, 2015 Accepting new patients

Locations

1202 Grand Ave
Wausau, WI 54403
Phone (715) 842-7711

601 S 32nd Ave
Wausau, WI 54401
Phone (715) 848-1741

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1198022400000",
    "number": "1730285701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S 32ND AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544013958",
            "telephone_number": "715-848-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 GRAND AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544036690",
            "telephone_number": "715-842-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDQUIST",
        "first_name": "COREY",
        "middle_name": "M",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2007-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2345-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38838500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350041604",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SECURITY HEALTH PLAN",
            "identifier": "26525",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "38987500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.

Verify at the official NPI Registry.