BELLEVUE TOTAL HEALTH, SC (NPI# 1447203013) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447203013 |
| Entity Type | Organization |
| Organization Name | BELLEVUE TOTAL HEALTH, SC |
| Practice Address |
2763 Manitowoc Rd Ste B Green Bay WI 54311-6633 |
| Practice Telephone | 9204688288 |
| Practice Fax Number | 9204689887 |
| Mailing Telephone | 9204688288 |
| Mailing Fax Number | 9204689887 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | BRADLEY J KENNY (OWNER/CHIROPRACTOR) |
| Authorized Official Telephone | 9204688288 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 111N00000X | Chiropractor | 2502-012 | WI | Chiropractic Providers |
| X | 111N00000X | Chiropractor | 4214-012 | WI | Chiropractic Providers |
| X | 207R00000X | Internal Medicine | 25884-020 | WI | Allopathic & Osteopathic Physicians |
| X | 363LX0106X |
Nurse Practitioner Specialization: Occupational Health |
1221-033 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21250700 | 05 | |
| WI | 39002800 | 05 |
| Street Address |
2763 MANITOWOC RD STE B |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54311-6633 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992774160 | Thomas Joseph Leonard | Internal Medicine | 2763 Manitowoc Rd, Suite B, Green Bay, WI 54311-6633 | 2006-03-17 |
| 1801212089 | Melinda C Heimerl | Physical Therapy Assistant | 2763 Manitowoc Rd, Ste B, Green Bay, WI 54311-6633 | 2014-03-11 |
| 1902164221 | Lindsey Charles Krouth | Physical Therapy Assistant | 2763 Manitowoc Rd, Ste B, Green Bay, WI 54311-6633 | 2012-04-24 |
| 1164706511 | Amy Jo Haverkorn | Physical Therapy Assistant | 2763 Manitowoc Rd, Suite B, Green Bay, WI 54311-6633 | 2011-10-04 |
| 1174703235 | Rejaunne M Kubik | Physical Therapist | 2763 Manitowoc Rd, Ste B, Green Bay, WI 54311-6633 | 2007-11-06 |
| 1588623482 | Bradley John Kenny | Chiropractor | 2763 Manitowoc Rd, Suite B, Green Bay, WI 54311-6633 | 2006-03-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295333847 | Karen Ginnow | Pharmacist | Walmart #1908, 2292 Main St, Green Bay, WI 54311 | 2020-10-15 |
| 1639786551 | Maggie Hall | Dental Hygienist | 2633 Development Dr. Ste 40, Green Bay, WI 54311 | 2020-09-24 |
| 1295370807 | Jennifer Marie Arendt | Technician | 2970 Mossy Oak Cir #39, Green Bay, WI 54311 | 2019-11-07 |
| 1518508803 | Cheryl Ann Johnson | Specialist | 830 Edgewood Dr., Green Bay, WI 54311 | 2019-10-08 |
| 1124670898 | Robert H Wagner Family Dentist S.c. | Dentist | 2830 Curry Court, Suite 1, Green Bay, WI 54311 | 2019-07-12 |
| 1821659624 | The Salvation Army | Counselor | The Salvation Army Ray & Joan Kroc Center, 1315 Lime Kiln Road, Green Bay, WI 54311 | 2019-06-24 |
| 1578052866 | Matthew Robert Wagner | Dentist | 2830 Curry Ln #1, Green Bay, WI 54311 | 2018-05-02 |
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1851844161 | Green Bay Family Dental LLC | Dentist | 2609 Development Dr., Green Bay, WI 54311 | 2016-08-03 |
| 1710382809 | Betsy Hoida | Pharmacist | 2485 Greenbrier Rd., Green Bay, WI 54311 | 2014-10-31 |
| Find all providers in zip 54311 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861916769 | Atlas Spinal Care | Chiropractor | 2069 Central Ct, Suite 11, Green Bay, WI 54311 | 2017-08-01 |
| 1376067413 | Tyler Allen Malueg | Chiropractor | 2069 Central Ct Ste 11, Green Bay, WI 54311-4281 | 2017-07-31 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1982082277 | Matthew Hallam | Chiropractor | 1541 Bellevue St Ste 5, Green Bay, WI 54311-6266 | 2015-05-07 |
| 1861893018 | Leah Hetebrueg | Chiropractor | 2066 Central Dr, Unit D, Green Bay, WI 54311-4244 | 2014-09-08 |
| 1518368836 | Jesse Anderson | Chiropractor | 982 N Taylor St, Green Bay, WI 54303-1202 | 2014-09-05 |
| 1043556780 | Kellen James Binder | Chiropractor | 2638 Tulip Lane, Suite B, Green Bay, WI 54313 | 2012-12-28 |
| 1083980981 | Healthy Living Chiropractic Clinic Inc. | Chiropractor | 858 Hansen Rd, Green Bay, WI 54304-5324 | 2012-03-26 |
| 1730409111 | Cornerstone Chiropractic Sc | Chiropractor | 2763 S Oneida St, Green Bay, WI 54304-5750 | 2010-06-08 |
| 1689906240 | Hazuka Spinal Center Inc | Chiropractor | 1742 E Mason St, Green Bay, WI 54302-3259 | 2010-02-08 |
| Find all providers in GREEN BAY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.