NPIMap

Organization Active NPI

Chiropractic Company S.C.

Doing business as Chiropractic Company

  • Chiropractor
  • Glendale, WI
National Provider Identifier
1972667913
Registry record updated Aug 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
CHIROPRACTIC COMPANY S.C.
Doing business as
Chiropractic Company
Practice address
5306 N Port Washington Rd
Glendale, WI 53217-4913
Phone
(414) 332-0859
Fax
(414) 332-3991
NPI assigned
Dec 21, 2006
Last updated
Aug 12, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2020

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

Authorized official

Name
Dr. Bryan R Gerondale, DC CC SPNPI 1598852147
Title
President
Phone
(414) 332-0859

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

5306 N Port Washington Rd
Glendale, WI 53217-4913

Mailing address

5306 N Port Washington Rd
Glendale, WI 53217-4913
Phone (414) 332-0859

Other names 1

  • Chiropractic Company Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040701000188 WI Part B Supplier - Clinic/Group Practice 9436136140 Receives reassigned benefits from 5 practitioners
Practice locations: Glendale, WI

National Provider Directory

National Provider Directory
Tax ID family
Chiropractic Company SC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 24

Organizations listed as members of this organization in the National Provider Directory.

View all 24

Locations

326 W Silver SPG Dr
Glendale, WI 53217

5306 N Port Washington Rd
Glendale, WI 53217
Phone (414) 322-0859

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597190400000",
    "number": "1972667913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5306 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174913",
            "telephone_number": "414-332-0859",
            "fax_number": "414-332-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5306 N PORT WASHINGTON RD",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532174913",
            "telephone_number": "414-332-0859",
            "fax_number": "414-332-3991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHIROPRACTIC COMPANY S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-21",
        "last_updated": "2020-08-12",
        "certification_date": "2020-08-12",
        "status": "A",
        "authorized_official_last_name": "GERONDALE",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-332-0859",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC CC SP"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chiropractic Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.