Unknown Individual – Chiropractor, NPI 1174629026

Unknown Individual is a healthcare provider. based in Fond du lac, Wisconsin. specializing in Chiropractor. They hold a License No. WI2923 (WI). The NPI Number for Unknown Individual is 1174629026

Main info

Organization
Inactive
34 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1174629026
Phone
(920) 921-9100
Address
952 SOUTH PARK AVENUE
Deactivation Date
22 May 2024

Doctor Profile

Medical School Name
LOGAN COLLEGE OF CHIROPRACTIC
Secondary Phone
9209219100
Graduation Year
1992 (34 years ago)
PAC ID
4486816774
Group Practice PAC ID
2769644053
Professional Enrollment ID
I20120502000680
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 952, South Park Avenue, Fond du Lac, Fond du Lac County, Wisconsin, 54935, United States

    FOND DU LAC, WI 54935

    Phone: (920) 921-9100

    Fax: (920) 929-0464

    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.

No Medicare enrollment or revalidation data available for this provider in our database.

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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
98941Chiropractic manipulative treatment, 3-4 spinal regions9522$0
98940Chiropractic manipulative treatment, 1-2 spinal regions5519$0
View full utilization report →

Insurance plans in this area (ZIP 54935)

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Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1174629026?
NPI 1174629026 belongs to Unknown Individual; compare other details if you need extra assurance.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Chiropractor. Clinical services aligned with this taxonomy classification.
Where in Wisconsin is Unknown Individual registered?
Use Fond Du Lac, Wisconsin as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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