Health Source Shorewood

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4856 Issued in MN

Legal business name

HEALTH SOURCE SHOREWOOD

Practice address

6140 Lake Linden Dr
Suite 100
Excelsior, MN 55331-2954

Phone

(952) 474-0886

NPI assigned

Aug 31, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Howard Fidler, DC

Title

President

Phone

(952) 474-0886

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251676800000",
    "number": "1013140599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6140 LAKE LINDEN DR",
            "address_2": "SUITE 100",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553312954",
            "telephone_number": "952-474-0886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6140 LAKE LINDEN DR",
            "address_2": "SUITE 100",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553312954",
            "telephone_number": "952-474-0886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTH SOURCE SHOREWOOD",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "last_updated": "2009-08-31",
        "status": "A",
        "authorized_official_last_name": "FIDLER",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-474-0886",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4856",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Dawn Hanninen, DMD
• Shelley Harmer, MT
• Lori Harrington
• David Harvieux, DDS
• Angela M Hastings, DMD
• Carolyn Rose Heise
• Sara Jo Helman, L.M.T
• Sarah R Hjersjo, D.C.
• Kathryn Marie Hoch, P.T.
• Krisana Marie Hoff

• Chiropractor in Excelsior, MN
• Providers in Excelsior, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; 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.