Jacob Jon Desantis

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5417 Issued in WI

Practice address

16 W John St Ste 3
Rice Lake, WI 54868-2918

Phone

(715) 205-5564

NPI assigned

Nov 1, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wild Rivers Chiropractic LLCGroup PAC ID 9032447297, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Wild Rivers Chiropractic LLC

  • Chiropractor
  • Rice Lake, WI
  • NPI 1649831132
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1541030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776470400000",
    "number": "1952878415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 W JOHN ST STE 3",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548682918",
            "telephone_number": "715-205-5564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 W JOHN ST STE 3",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548682918",
            "telephone_number": "715-205-5564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANTIS",
        "first_name": "JACOB",
        "middle_name": "JON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-01",
        "last_updated": "2026-04-18",
        "certification_date": "2026-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary R Degerman, MD
• Jonathon E Delf
• Tia Marie Demers, PT, DPT
• Paula Marie Denn, PT
• Amber Derousseau, RBT
• Diagnostic Radiology Associates of Wisconsin SC
• Liana Dietrich
• Jennifer Marie Donahue, OTR/L
• Andrea Elizabeth Doty, OTR/L
• Douglas J. Raether, M.D., S.C.

• Chiropractor in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2026; 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.

Verify at the official NPI Registry.