DR. WALTER RUDOLPH WIESZTORT D.C.
NPI 1003814336
Chiropractor in Kenosha, WI

Active since July 11, 2005Accepts Medicare Assignment
4014 77TH ST, STE. 2, KENOSHA, WI 53142(262) 694-3530(262) 925-8810 Get Directions Write a Review

NPPES record last updated: April 22, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Dr. Walter Rudolph Wiesztort D.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. WALTER RUDOLPH WIESZTORT D.C. (NPI 1003814336) is an individual chiropractor in Kenosha, Wisconsin, licensed in Wisconsin (3514-012) and active in the NPI registry since July 2005. He is a graduate of Palmer College Chiropractic - Davenport (1997).

NPPES Registry Identity

NPI1003814336
Entity TypeIndividualMale
Primary Taxonomy111N00000X
Provider Legal NameDR. WALTER RUDOLPH WIESZTORTCredential: D.C.
Location Address4014 77TH ST, STE. 2Kenosha, WI 53142-4314
Mailing Address4014 77th St, Ste. 2Kenosha, WI 53142-4314 · (262) 694-3530 · Fax (262) 925-8810
Fax(262) 925-8810
Sole ProprietorNo
Medical School CMSPalmer College Chiropractic - DavenportGraduated 1997
Enumeration DateJuly 11, 2005
Last NPPES UpdateApril 22, 2008
NPI 1003814336 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
License Licensed in WI · 3514-012
Definition

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.

4014 77TH ST, Kenosha, WI 53142

Other Identifiers 8

Other0005896742Aetna
Other4400259Uhc
Other0191565Cigna
Other521540114Macs
Medicare UPINU75790WI
Medicare ID-Type Unspecified35423WI
Medicaid38911900WI
Other721524922010WI · Blue Cross Blue Shield

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Walter Rudolph Wiesztort D.c. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7719077619
PECOS Enrollment IDI20071215000118

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Optometrist
4014 77TH ST
KENOSHA, WI 53142
Durable Medical Equipment & Medical Supplies
4014 77TH ST
KENOSHA, WI 53142

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Walter Wiesztort's NPI number?

The NPI number for Walter Wiesztort is 1003814336. It was assigned to this individual provider in the NPPES registry on July 11, 2005.

Where is Walter Wiesztort located?

Walter Wiesztort practices at 4014 77th St Ste. 2, Kenosha, WI 53142. The listed phone number is (262) 694-3530.

What is Walter Wiesztort's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Walter Wiesztort enrolled in Medicare?

Yes. Walter Wiesztort is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Walter Wiesztort was last updated on April 22, 2008. NPI Profile syncs with the weekly NPPES data releases published by CMS.