Active NPI
John Henry Etzweiler, D.C.
- Chiropractor
- Mequon, WI
National Provider Identifier
1952445140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 1733-012
- Practice address
- 11402 N Port Washington Rd
Suite 105
Mequon, WI 53092-3447 - Phone
- (262) 241-4647
- NPI assigned
- Feb 19, 2007
- 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 | 1733-012 | WI | Primary |
Addresses
Primary practice location
11402 N Port Washington Rd
Suite 105
Mequon, WI 53092-3447
Mailing address
11402 N Port Washington Rd
Suite 105
Mequon, WI 53092-3447
Phone (262) 241-4647
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1733-012 | WI | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1952445140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11402 N PORT WASHINGTON RD",
"address_2": "SUITE 105",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923447",
"telephone_number": "262-241-4647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11402 N PORT WASHINGTON RD",
"address_2": "SUITE 105",
"city": "MEQUON",
"state": "WI",
"postal_code": "530923447",
"telephone_number": "262-241-4647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETZWEILER",
"first_name": "JOHN",
"middle_name": "HENRY",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "WI",
"license": "1733-012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.