Organization Active NPI

Tonderum Family Chiropractic PLLC

  • Chiropractor
  • Waite Park, MN
National Provider Identifier
1003390063
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
TONDERUM FAMILY CHIROPRACTIC PLLC
Practice address
171 7TH Ave S
Waite Park, MN 56387-1362
Phone
(320) 744-1013
NPI assigned
Sep 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tyler Tonderum, DC
Title
President
Phone
(712) 209-2597

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

171 7TH Ave S
Waite Park, MN 56387-1362

Mailing address

50 10TH Ave S
Waite Park, MN 56387-1055
Phone (320) 774-1013

Other names 1

  • Legacy Family Chiropractic Doing business as

National Provider Directory

National Provider Directory

Locations

50 10th Ave S
Waite Park, MN 56387
Phone (320) 230-9939

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1003390063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 10TH AVE S",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871055",
            "telephone_number": "320-774-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 7TH AVE S",
            "city": "WAITE PARK",
            "state": "MN",
            "postal_code": "563871362",
            "telephone_number": "320-744-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TONDERUM FAMILY CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-17",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "TONDERUM",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "712-209-2597",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Legacy Family Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waite Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.