Advanced Chiropractic of Green Bay LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3102 Issued in WI

Legal business name

ADVANCED CHIROPRACTIC OF GREEN BAY LLC

Practice address

2149 Velp Ave
Suite 300
Green Bay, WI 54303-5424

Phone

(920) 434-7393

Fax

(920) 434-7394

NPI assigned

Feb 23, 2012

Organization subpart

No

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kay Ann Fogeltanz, DC

  • Chiropractor
  • Green Bay, WI
  • NPI 1184715146
  NPD (past)

Locations

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

Authorized official

Name

Dr. Kevin J Pursel, DC

Title

Managing Member/Owner

Phone

(920) 434-7393

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329955200000",
    "number": "1780958637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2149 VELP AVE",
            "address_2": "SUITE 300",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543035424",
            "telephone_number": "920-434-7393",
            "fax_number": "920-434-7394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2149 VELP AVE",
            "address_2": "SUITE 300",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543035424",
            "telephone_number": "920-434-7393",
            "fax_number": "920-434-7394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED CHIROPRACTIC OF GREEN BAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-23",
        "last_updated": "2012-02-23",
        "status": "A",
        "authorized_official_last_name": "PURSEL",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING MEMBER/OWNER",
        "authorized_official_telephone_number": "920-434-7393",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "388-78-200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Green Bay, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; 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.