Organization Active NPI

Wellness Chiropractic Center LLC

  • Chiropractor
  • Watertown, WI
National Provider Identifier
1952467995
Registry record updated Sep 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3025 Issued in WI
Legal business name
WELLNESS CHIROPRACTIC CENTER LLC
Practice address
816 West St
Watertown, WI 53094-3608
Phone
(920) 262-0200
Fax
(920) 262-0210
NPI assigned
Dec 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2010

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

Authorized official

Name
Dr. Jane E Brotski, DC DICCP
Title
Co Owner
Phone
(920) 262-0200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3025 WI Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 3149 WI

Addresses

Primary practice location

816 West St
Watertown, WI 53094-3608

Mailing address

816 West St
Watertown, WI 53094-3601
Phone (920) 262-0200

Other identifiers 2

IdentifierTypeStateIssuer
000235820OtherWIMEDICARE
000135820OtherWIMEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150615000042 WI Part B Supplier - Clinic/Group Practice 7012070238 Receives reassigned benefits from 1 practitioner
Practice locations: Watertown, WI

National Provider Directory

National Provider Directory

Locations

816 West St
Watertown, WI 53094
Phone (920) 262-0200

Practitioners & affiliated clinicians

Practitioners 1

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": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285286400000",
    "number": "1952467995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "816 WEST ST",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530943601",
            "telephone_number": "920-262-0200",
            "fax_number": "920-262-0210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 WEST ST",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530943608",
            "telephone_number": "920-262-0200",
            "fax_number": "920-262-0210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS CHIROPRACTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2010-09-24",
        "status": "A",
        "authorized_official_last_name": "BROTSKI",
        "authorized_official_first_name": "JANE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "920-262-0200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC DICCP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3025",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3149",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000235820",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "000135820",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; 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.