LAKE DELTON CHIROPRACTIC CLINIC LLC NPI 1619087871

NPI Information

  • NPI: 1619087871
  • Provider Name: LAKE DELTON CHIROPRACTIC CLINIC LLC
  • Classification: Chiropractor - 111N00000X
  • Entity Type: Organization
  • Doing Business As: HEALTHSOURCE CHIROPRACTIC & PROGRESSIVE WELLNESS
  • Address: 151 WISCONSIN DELLS PKWY S
    WISCONSIN DELLS, WI
    ZIP 53965
  • Phone: (608) 253-0102

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NPI Details

LAKE DELTON CHIROPRACTIC CLINIC LLC is a chiropractor in Wisconsin Dells, WI. The provider is 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. LAKE DELTON CHIROPRACTIC CLINIC LLC NPI is 1619087871. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Healthsource Chiropractic & Progressive Wellness.

The provider's business location address is:

151 WISCONSIN DELLS PKWY S
WISCONSIN DELLS, WI
ZIP 53965
Phone: (608) 253-0102
Fax: (608) 253-0188

The provider's authorized official is Todd Joseph Bauer .
The authorized official title is Owner and has the following contact phone number (608) 697-9994.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 5/17/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractor4029-012WISCONSINYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
139000300MEDICAIDWISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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