Brian E Formolo, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3364 Issued in WI

Practice address

1900 W Ryan Rd
Oak Creek, WI 53154-8233

Phone

(414) 761-5777

Fax

(414) 761-7915

NPI assigned

Jun 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oak Creek Relief and Wellness SCGroup PAC ID 8426014820, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Oak Creek Relief and Wellness SC

  • Chiropractor
  • Oak Creek, WI
  • NPI 1205979937
  Medicare reassignment Care Compare group NPD
• At-Home Auto Accident Treatment, LLC

  • Chiropractor
  • West Allis, WI
  • NPI 1053756700
  NPD (past) Authorized official
• National Chiropractic, LLC

  • Chiropractor
  • West Allis, WI
  • NPI 1235398272
  NPD (past) Authorized official

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721260800000",
    "number": "1760427207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 W RYAN RD",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548233",
            "telephone_number": "414-761-5777",
            "fax_number": "414-761-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 W RYAN RD",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531548233",
            "telephone_number": "414-761-5777",
            "fax_number": "414-761-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORMOLO",
        "first_name": "BRIAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2024-07-18",
        "certification_date": "2024-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH12750",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Robert Fisher Jr., DC
• Kelsey A Fitzgerald, DPT
• Five Star Rehabilitation and Wellness Services, LLC
• Kathleen S Fons
• Forefront Dermatology, S.C.
• Isadore D Forton Lesure
• Ariel Rose Fountain, LPC-IT
• Mikayla Louise Fox
• Rebecca J Fox, DPT
• Melissa Jane Franke, PT

• Chiropractor in Oak Creek, WI
• Providers in Oak Creek, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2024; 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.