NPIMap

Organization Active NPI

Bauer Chiropractic, LLC

  • Chiropractor
  • Fond Du Lac, WI
National Provider Identifier
1861421604
Registry record updated Apr 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3462 Issued in WI
Legal business name
BAUER CHIROPRACTIC, LLC
Practice address
355 N Peters Ave
Fond Du Lac, WI 54935-8258
Phone
(920) 923-3322
Fax
(920) 923-3322
NPI assigned
Jul 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2009

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

Authorized official

Name
Dr. Shayne Michael Bauer, DCNPI 1063444982
Title
Owner
Phone
(920) 923-3322

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3462 WI Primary

Addresses

Primary practice location

355 N Peters Ave
Fond Du Lac, WI 54935-8258

Mailing address

355 N. Peters Ave.
PO Box 1898
Fond Du Lac, WI 54935
Phone (920) 923-3322

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609001119 WI Part B Supplier - Clinic/Group Practice 9032192265 Receives reassigned benefits from 1 practitioner
Practice locations: Fond Du Lac, WI

National Provider Directory

National Provider Directory

Locations

85 N Pioneer Rd
Fond du Lac, WI 54935
Phone (920) 923-3300

Practitioners & affiliated clinicians

Practitioners 4

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": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1241049600000",
    "number": "1861421604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 N. PETERS AVE.",
            "address_2": "PO BOX 1898",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "54935",
            "telephone_number": "920-923-3322",
            "fax_number": "920-923-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 N PETERS AVE",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358258",
            "telephone_number": "920-923-3322",
            "fax_number": "920-923-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAUER CHIROPRACTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2009-04-30",
        "status": "A",
        "authorized_official_last_name": "BAUER",
        "authorized_official_first_name": "SHAYNE",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-923-3322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2009; 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.