Watertown Chiropractic SC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3037012 Issued in WI

Legal business name

WATERTOWN CHIROPRACTIC SC

Practice address

615 E Main St
Suite B
Watertown, WI 53094-3200

Phone

(920) 261-2204

Fax

(920) 261-3901

NPI assigned

Jul 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jeffrey C Fruendt, DC

Title

President Watertown Chiropractic

Phone

(920) 261-2204

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475539200000",
    "number": "1972529352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 E MAIN ST",
            "address_2": "SUITE B",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530943200",
            "telephone_number": "920-261-2204",
            "fax_number": "920-261-3901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 E MAIN ST",
            "address_2": "SUITE B",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530943200",
            "telephone_number": "920-261-2204",
            "fax_number": "920-261-3901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN CHIROPRACTIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2016-10-04",
        "status": "A",
        "authorized_official_last_name": "FRUENDT",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT WATERTOWN CHIROPRACTIC",
        "authorized_official_telephone_number": "920-261-2204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "3037012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38992600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "000035420",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Lynn Walter, LPC-IT
• Mandy Walter, RN
• Patrice Walter, OTR
• Watertown Anesthesia, LLC
• Watertown Anesthesiology SC
• Watertown Emergency Physicians
• Watertown Emergency Physicians, S.C.
• Watertown Family Practice Associates S.C.
• Watertown Heart Institute SC
• Watertown Hometown Pharmacy LLC

• Chiropractor in Watertown, WI
• Providers in Watertown, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.