Organization Active NPI

Dr Michael W Zoelle SC

  • Chiropractor
  • Green Bay, WI
National Provider Identifier
1770601791
Registry record updated Nov 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2216-012 Issued in WI
Legal business name
DR MICHAEL W ZOELLE SC
Practice address
2420 Finger Rd
Green Bay, WI 54302-4210
Phone
(920) 465-6040
Fax
(920) 465-4464
NPI assigned
Mar 27, 2007
Last updated
Nov 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2017

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

Authorized official

Name
Dr. Michael W ZoelleNPI 1487696571
Title
Owner
Phone
(920) 465-6040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2216-012 WI Primary

Addresses

Primary practice location

2420 Finger Rd
Green Bay, WI 54302-4210

Mailing address

2420 Finger Rd
Green Bay, WI 54302-4210
Phone (920) 465-6040

Other identifiers 2

IdentifierTypeStateIssuer
38798400MedicaidWI
1487696571OtherWINPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051207000372 WI Part B Supplier - Clinic/Group Practice 7810917705 Receives reassigned benefits from 5 practitioners
Practice locations: Green Bay, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509580800000",
    "number": "1770601791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 FINGER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543024210",
            "telephone_number": "920-465-6040",
            "fax_number": "920-465-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 FINGER RD",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543024210",
            "telephone_number": "920-465-6040",
            "fax_number": "920-465-4464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR MICHAEL W ZOELLE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2017-11-02",
        "status": "A",
        "authorized_official_last_name": "ZOELLE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-465-6040",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2216-012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38798400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1487696571",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.