LAKE DELTON CHIROPRACTIC CLINIC LLC (NPI# 1619087871) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619087871 |
| Entity Type | Organization |
| Organization Name | LAKE DELTON CHIROPRACTIC CLINIC LLC |
| Other Organization Name | HEALTHSOURCE CHIROPRACTIC & PROGRESSIVE WELLNESS |
| Practice Address |
151 Wisconsin Dells Pkwy S Wisconsin Dells WI 53965 |
| Practice Telephone | 6082530102 |
| Practice Fax Number | 6082530188 |
| Mailing Telephone | 6082530102 |
| Mailing Fax Number | 6082530188 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-05-17 |
| Authorized Official Name | DR. TODD JOSEPH BAUER (OWNER) |
| Authorized Official Telephone | 6086979994 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 4029-012 | WI | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 39000300 | 05 |
| Other Name | Type Code |
|---|---|
| HealthSource Chiropractic & Progressive Wellness | Doing Business As Name - Organization |
| Street Address |
151 WISCONSIN DELLS PKWY S |
| City | WISCONSIN DELLS |
| State | WI |
| Zip Code | 53965 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609981380 | Todd Joseph Bauer | Chiropractor | 151 Wisconsin Dells Pkwy S, Wisconsin Dells, WI 53965-8304 | 2006-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437791811 | Doris Marie Delmore | Technician | 803 Clara Ave, Wi Dells, WI 53965 | 2019-10-17 |
| 1598200081 | Britney Ann Leege | Physical Therapy Assistant | N9474 County Road O, Wisconsin Dells, WI 53965 | 2016-12-20 |
| 1073619201 | Travelmart Inc. | Pharmacy | 802 Broadway, Wisconsin Dells, WI 53965 | 2006-09-15 |
| 1235588773 | Lori J Spencer | Nurse Practitioner | 1310 Broadway, Wisconsin Dells, WI 53965 | 2016-06-06 |
| 1821199506 | Daniel Edward Joseph | Chiropractor | 1000 St Hwy 13, Wisconsin Dells, WI 53965-0049 | 2006-09-26 |
| 1720280522 | Joseph Chiropractic Sc | Chiropractor | 1000 St Hwy 13, Wisconsin Dells, WI 53965-0049 | 2007-06-04 |
| 1104084342 | Casey Meyer Piotrowski | Occupational Therapist | 1010 Hillside Ct, Wisconsin Dells, WI 53965-1309 | 2008-05-23 |
| 1760434435 | Kenneth G Forsythe | Optometrist | 1302 Broadway, Wisconsin Dells, WI 53965-1358 | 2006-05-17 |
| 1447215868 | Elizabeth R Bostwick | Nurse Practitioner | 1310 Broadway, Wisconsin Dells, WI 53965-1358 | 2006-04-19 |
| 1205891439 | Renato T Faylona | Surgery | 1310 Broadway Rd, Wisconsin Dells, WI 53965-1358 | 2006-04-19 |
| Find all providers in zip 53965 | ||||
| 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 |
|---|---|---|---|---|
| 1962610949 | Duane Michael Fedewa | Chiropractor | 719 Vine St, Wisconsin Dells, WI 53965-1621 | 2007-05-21 |
| 1821199506 | Daniel Edward Joseph | Chiropractor | 1000 St Hwy 13, Wisconsin Dells, WI 53965-0049 | 2006-09-26 |
| 1609981380 | Todd Joseph Bauer | Chiropractor | 151 Wisconsin Dells Pkwy S, Wisconsin Dells, WI 53965-8304 | 2006-08-20 |
| 1720280522 | Joseph Chiropractic Sc | Chiropractor | 1000 St Hwy 13, Wisconsin Dells, WI 53965-0049 | 2007-06-04 |
| 1417165473 | Diana Marshall Fedewa | Chiropractor | 719 Vine St, Wisconsin Dells, WI 53965-1621 | 2007-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518567668 | Zachary Arnold Wickert | Chiropractor | N144w6220 Pioneer Rd, Cedarburg, WI 53012-2723 | 2020-10-28 |
| 1215537501 | Seek Chiropractic LLC | Chiropractor | 405 S Farwell St Ste 21, Eau Claire, WI 54701-2701 | 2020-10-27 |
| 1043819824 | Courtney Helen Slaby | Chiropractor | 559 Braund St Ste 3, Onalaska, WI 54650-8659 | 2020-10-22 |
| 1548869423 | Journey Chiropractic LLC | Chiropractor | 101 E Sadd St, North Prairie, WI 53153-9775 | 2020-10-21 |
| 1154929909 | Water City Care Mission, Inc. | Chiropractor | 449 High Ave., Oshkosh, WI 54901-4708 | 2020-10-14 |
| 1366049793 | Phoenix Chiropractic and Wellness, LLC | Chiropractor | 250 N Green Bay Rd Unit D, Neenah, WI 54956-2285 | 2020-10-08 |
| 1598371668 | Michael Allen Markowski | Chiropractor | 1632 N 18th St # 1, Manitowoc, WI 54220-1858 | 2020-09-23 |
| 1801408687 | Chiro One Wellness Center of Pleasant Prairie LLC | Chiropractor | 9755 76th St Ste 730, Pleasant Prairie, WI 53158-1925 | 2020-08-21 |
| 1972115186 | Shelby Chapelle | Chiropractor | 1711 Green Bay Rd Ste C, Kenosha, WI 53144-1209 | 2020-08-19 |
| 1659981801 | Reince Chiropractic LLC | Chiropractor | 13382 Velp Ave Ste A, Suamico, WI 54313-8191 | 2020-08-03 |
| Find all providers with the same taxonomy | ||||
| City | WISCONSIN DELLS |
| Zip Code | 53965 |
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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.