NPIMap

Organization Active NPI

Integrative Chiropractic and Wellness

  • Chiropractor
  • Hartland, WI
National Provider Identifier
1881634608
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3876-012 Issued in WI
Legal business name
INTEGRATIVE CHIROPRACTIC AND WELLNESS
Practice address
520 Hartbrook Dr Ste H
Hartland, WI 53029-1405
Phone
(262) 369-7900
NPI assigned
Jun 8, 2006
Last updated
Jan 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Authorized official

Name
Jonathan Romeo Lo, DCNPI 1770522336
Title
Owner
Phone
(262) 369-7900

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 3876-012 WI Primary

Addresses

Primary practice location

520 Hartbrook Dr Ste H
Hartland, WI 53029-1405

Mailing address

520 Hartbrook Dr Ste H
Hartland, WI 53029-1405
Phone (262) 369-7900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060620000059 WI Part B Supplier - Clinic/Group Practice 8325050073 Receives reassigned benefits from 1 practitioner
Practice locations: Hartland, WI

National Provider Directory

National Provider Directory

Locations

W330N4339 Lakeland Dr
Unit A
Nashotah, WI 53058
Phone (262) 369-7900

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": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1881634608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 HARTBROOK DR STE H",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530291405",
            "telephone_number": "262-369-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 HARTBROOK DR STE H",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530291405",
            "telephone_number": "262-369-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE CHIROPRACTIC AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "LO",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "ROMEO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-369-7900",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3876-012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartland, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.