Active NPI
Jackson Detrick
- Chiropractor
- Altoona, WI
National Provider Identifier
1760946743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5425-12
- Practice address
- 1893 Whistling Straits Dr
Altoona, WI 54720-2259 - Phone
- (715) 828-3245
- NPI assigned
- Jan 24, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5425-12 | WI | Primary |
Addresses
Primary practice location
1893 Whistling Straits Dr
Altoona, WI 54720-2259
Mailing address
1893 Whistling Straits Dr
Altoona, WI 54720-2259
Phone (715) 828-3245
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5425-12 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548288000000",
"number": "1760946743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1893 WHISTLING STRAITS DR",
"city": "ALTOONA",
"state": "WI",
"postal_code": "547202259",
"telephone_number": "715-828-3245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1893 WHISTLING STRAITS DR",
"city": "ALTOONA",
"state": "WI",
"postal_code": "547202259",
"telephone_number": "715-828-3245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETRICK",
"first_name": "JACKSON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-24",
"last_updated": "2019-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "5425-12",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altoona, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.