Craig Roy Kaddatz, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2538 Issued in MN

Practice address

130 1St Street W #108
Canby, MN 56220-1145

Phone

(507) 233-7366

Fax

(507) 223-7366

NPI assigned

Mar 8, 2006

Sex

Male

Sole proprietor

Yes

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1988

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare fee-for-service enrollment

Enrolled in MN

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 21, 2022.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1003883034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 1ST STREET W #108",
            "city": "CANBY",
            "state": "MN",
            "postal_code": "562201145",
            "telephone_number": "507-223-7366",
            "fax_number": "507-223-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 1ST STREET W #108",
            "city": "CANBY",
            "state": "MN",
            "postal_code": "562201145",
            "telephone_number": "507-233-7366",
            "fax_number": "507-223-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KADDATZ",
        "first_name": "CRAIG",
        "middle_name": "ROY",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2538",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HSM ID",
            "identifier": "0851",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SVHP ID",
            "identifier": "22124",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7603720",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL ID",
            "identifier": "1DO74KA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE ID",
            "identifier": "15097",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID",
            "identifier": "59873KA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "602028300",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAKOTACARE ID",
            "identifier": "2038",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Canby, MN
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.