Prohealth Chiropractic Center SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4713-012 Issued in WI

Legal business name

PROHEALTH CHIROPRACTIC CENTER SC

Practice address

122 Green Bay Rd
Thiensville, WI 53092-1624

Phone

(262) 242-5577

NPI assigned

Jul 16, 2013

Organization subpart

Yes

Parent organization

PROHEALTH CHIROPRACTIC CENTER SCAs reported in NPPES

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

Authorized official

Name

Dr. Eric Stanenas, DCNPI 1457655847

Title

Owner

Phone

(920) 994-2000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Prohealth Chiropractic Center S.C.

  • Clinic/Center
  • Random Lake, WI
  • NPI 1699064022

  O20110526000637

  Same enrollment

Tax ID family

Prohealth Chiro Center SC2 organizations share this tax ID, including this one

Part of

Prohealth Chiro Center SC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prohealth Chiropractic Center S.C.

  • Clinic/Center
  • Random Lake, WI
  • NPI 1699064022
  NPD tax ID

Locations

Practitioners 2

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

• Eric Stanenas, D.C.

  • Chiropractor
  • Stevens Point, WI
  • NPI 1457655847
  NPD Authorized official
• James R. Shelstad, D.C.

  • Chiropractor
  • Thiensville, WI
  • NPI 1518047562
  NPD (past)

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1871934026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 GREEN BAY RD",
            "address_2": "P.O. BOX 574",
            "city": "THIENSVILLE",
            "state": "WI",
            "postal_code": "530921624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 GREEN BAY RD",
            "city": "THIENSVILLE",
            "state": "WI",
            "postal_code": "530921624",
            "telephone_number": "262-242-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH CHIROPRACTIC CENTER SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROHEALTH CHIROPRACTIC CENTER SC",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "STANENAS",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-994-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4713-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Thiensville, WI
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; 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.