Active NPI
Shane Gallick, DC
- Chiropractor
- Lake Hallie, WI
National Provider Identifier
1932637204
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 5073
- Practice address
- 4753 County Highway J
Lake Hallie, WI 54729-3387 - Phone
- (720) 448-5274
- NPI assigned
- May 31, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5073 | WI | Primary |
Addresses
Primary practice location
4753 County Highway J
Lake Hallie, WI 54729-3387
Mailing address
4753 County Highway J
Lake Hallie, WI 54729-3387
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2014
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
4753 W Park Ave
Lake Hallie, WI 54729-2752
Phone (715) 861-2400
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Lake Hallie, WI
- NPI 1285162594
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496188800000",
"number": "1932637204",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4753 COUNTY HIGHWAY J",
"city": "LAKE HALLIE",
"state": "WI",
"postal_code": "547293387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4753 COUNTY HIGHWAY J",
"city": "LAKE HALLIE",
"state": "WI",
"postal_code": "547293387",
"telephone_number": "720-448-5274"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLICK",
"first_name": "SHANE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-05-31",
"last_updated": "2017-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "5073",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Hallie, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.