NPIMap

Organization Active NPI

Creekside Chiropractic and Rehabilitation, LTD.

  • Chiropractor
  • Sheboygan, WI
National Provider Identifier
1801076872
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4549-12 Issued in WI
Legal business name
CREEKSIDE CHIROPRACTIC AND REHABILITATION, LTD.
Practice address
4000 Enterprise Dr
Sheboygan, WI 53083-2245
Phone
(920) 459-9090
Fax
(920) 459-7426
NPI assigned
Nov 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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

Authorized official

Name
Andrew L Tislau, DCNPI 1538499827
Title
Chiropractor
Phone
(920) 459-9090

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 2308-12 WI
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 4058-012 WI
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 4549-12 WI Primary

Addresses

Primary practice location

4000 Enterprise Dr
Sheboygan, WI 53083-2245

Mailing address

4000 Enterprise Dr
Sheboygan, WI 53083-2245
Phone (920) 459-9090

Other identifiers 1

IdentifierTypeStateIssuer
38834800MedicaidWI

Other names 1

  • Creekside Chiropractic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051208000586 WI Part B Supplier - Clinic/Group Practice 8921029760 Receives reassigned benefits from 6 practitioners
Practice locations: Sheboygan, WI

National Provider Directory

National Provider Directory

Locations

4000 Enterprise Dr
Sheboygan, WI 53083
Phone (920) 286-2376

4027 S Business Dr
Sheboygan, WI 53081
Phone (920) 207-4440

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707350400000",
    "number": "1801076872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 ENTERPRISE DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530832245",
            "telephone_number": "920-459-9090",
            "fax_number": "920-459-7426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 ENTERPRISE DR",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530832245",
            "telephone_number": "920-459-9090",
            "fax_number": "920-459-7426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE CHIROPRACTIC AND REHABILITATION, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-07",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A",
        "authorized_official_last_name": "TISLAU",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "920-459-9090",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2308-12",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4058-012",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4549-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38834800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creekside Chiropractic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Creekside Chiropractic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sheboygan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; 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.