BLAU CHIROPRACTIC SC NPI 1003003716

Chiropractor in Portage, WI

Organization Chiropractor

About BLAU CHIROPRACTIC SC

Blau Chiropractic Sc is a provider established in Portage, Wisconsin specializing in chiropractor. The NPI number of Blau Chiropractic Sc is 1003003716 and was assigned on September 2007. The practitioner's primary taxonomy code is 111N00000X with license number 2990 (WI). The provider is registered as an organization and their NPI record was last updated 8 years ago. Blau Chiropractic Sc operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Kevin A Blau Dc (Chiropractor)

NPI

1003003716

Provider NameBLAU CHIROPRACTIC SC
Provider Location Address641 LATTON LN PORTAGE, WI 53901
Provider Mailing Address641 LATTON LN PORTAGE, WI 53901
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date09-26-2007
Last Update Date11-13-2012

Primary Taxonomy

Taxonomy Code111N00000X
ClassificationChiropractor
TypeChiropractic Providers
License No.2990
License StateWI
Taxonomy DescriptionA 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.

Business Address

BLAU CHIROPRACTIC SC
641 LATTON LN
PORTAGE, WI
ZIP 53901
Phone: (608) 742-1300
Fax: (608) 745-0147

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Mailing Address

BLAU CHIROPRACTIC SC
641 LATTON LN
PORTAGE, WI
ZIP 53901
Phone: (608) 742-1300
Fax: (608) 745-0147

Authorized Official

Authorized Official NameDR. KEVIN A BLAU DC
Authorized Official TitleCHIROPRACTOR
Authorized Official Phone(608) 742-1300

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
38887700MEDICAID (05)WI
000075332MEDICARE PIN (08)WI

Other Providers at the same location


The following 3 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1194237123 JESSICA ROSE DREDSKE DC
Individual
Chiropractor641 LATTON LN
PORTAGE, WI 53901
(608) 742-1300
1750610051DR. BRIAN DAVID HEEREN D.C.
Individual
Chiropractor641 LATTON LN
PORTAGE, WI 53901
(608) 742-1300
1932194172DR. KEVIN A. BLAU D.C.
Individual
Chiropractor641 LATTON LN SUITE A
PORTAGE, WI 53901
(608) 742-1300

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.