DR. WALTER RUDOLPH WIESZTORT (D.C.) – Chiropractor, NPI 1003814336

DR. WALTER RUDOLPH WIESZTORT (D.C.) is a healthcare provider. based in Kenosha, Wisconsin. specializing in CHIROPRACTIC. They hold the professional credentials D.C.. They hold a License No. 3514-012 (WI). The NPI Number for DR. WALTER RUDOLPH WIESZTORT (D.C.) is 1003814336

Main info

Male
29 Years Of Experience
Accepts Medicare Assignment
Name
DR. WALTER RUDOLPH WIESZTORT (D.C.)
NPI
1003814336
Phone
(262) 694-3530
Address
4014 77TH ST
Enumeration Date
11 July 2005
Deactivation Date
16 March 2006
Reactivation Date
24 March 2006
Last Update Date
22 April 2008

Doctor Profile

Medical School Name
PALMER COLLEGE CHIROPRACTIC - DAVENPORT
Secondary Phone
2626943530
Graduation Year
1997 (29 years ago)
PAC ID
7719077619
Professional Enrollment ID
I20071215000118
Address ID
WI531424314KE4014XSTXX301
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

1,617 CHIROPRACTIC in WI

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Provider Addresses for DR. WALTER RUDOLPH WIESZTORT (D.C.)

  • 4014, 77th Street, Kenosha, Kenosha County, Wisconsin, 53142, United States

    STE. 2

    KENOSHA, WI 531424314

    Phone: (262) 694-3530

    Fax: (262) 925-8810

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2007-12-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20071215000118IChiropracticWITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 53142)

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Reviews

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Frequently asked questions

Is DR. WALTER RUDOLPH WIESZTORT (D.C.) listed with a National Provider Identifier?
Yes — DR. WALTER RUDOLPH WIESZTORT (D.C.) has NPI 1003814336 on file in the registry.
Is there an active status for DR. WALTER RUDOLPH WIESZTORT (D.C.)?
For scheduling context, DR. WALTER RUDOLPH WIESZTORT (D.C.) is shown as active in the registry.
What area of care is associated with DR. WALTER RUDOLPH WIESZTORT (D.C.)?
DR. WALTER RUDOLPH WIESZTORT (D.C.)'s record emphasizes Chiropractor. Clinical services aligned with this taxonomy classification.
What practice footprint exists for DR. WALTER RUDOLPH WIESZTORT (D.C.)?
Travel planning: use Kenosha, Wisconsin as the reference point for DR. WALTER RUDOLPH WIESZTORT (D.C.), then confirm.
When was this NPI issued?
Enumeration for DR. WALTER RUDOLPH WIESZTORT (D.C.) is noted as July 11, 2005 where the registry provides it.

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