Chiropractic Company S.C.

Organization Active NPI Chiropractor · Glendale, WI

NPI 1972667913 · NPPES record last updated Aug 12, 2020

Key facts

NPI
1972667913
Entity type
Organization (NPI type 2)
Primary specialty
Chiropractor 111N00000X
Legal business name
CHIROPRACTIC COMPANY S.C.
Practice address
5306 N Port Washington Rd
Glendale, WI 53217-4913
Phone
(414) 332-0859
Fax
(414) 332-3991
NPI assigned
Dec 21, 2006
Organization subpart
No

Authorized official

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

Corporate family (same 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.

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records

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

Tax ID family
Chiropractic Company SC (2 organizations share this tax ID)

Locations

W164N11297 Squire Dr
Germantown, WI 53022
Phone (262) 250-1948

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

326 W Silver SPG Dr
Glendale, WI 53217

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor
Group: 193400000X SINGLE SPECIALTY GROUP
111N00000X Yes

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 identifiers

IdentifierTypeStateIssuer
38989100MedicaidWI

Other names

  • Chiropractic Company Doing business as

Other providers in Glendale, WI

All providers in Glendale, WI · Chiropractor in Wisconsin

Sources for this page

Verify at the official NPI Registry.