Active NPI
Matthew Vradenburg, DC
- Chiropractor
- Minnetonka, MN
National Provider Identifier
1043831225
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 7187
- Practice address
- 11500 Wayzata Blvd PMB 1025
Minnetonka, MN 55305 - Phone
- (763) 260-1469
- NPI assigned
- Apr 29, 2020
- Last updated
- Oct 1, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 11698237-8007 | UT | |
| Chiropractor | 111N00000X | 7187 | MN | Primary |
Addresses
Primary practice location
11500 Wayzata Blvd PMB 1025
Minnetonka, MN 55305
Mailing address
6300 Virginia Ave N
Brooklyn Park, MN 55428-2162
Phone (763) 267-1455
Other practice location 1
229 E Saint George Blvd Ste 105
St George, UT 84770-7902
Phone (435) 674-1926
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7187 | MN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727740800000",
"number": "1043831225",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6300 VIRGINIA AVE N",
"city": "BROOKLYN PARK",
"state": "MN",
"postal_code": "554282162",
"telephone_number": "763-267-1455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11500 WAYZATA BLVD PMB 1025",
"city": "MINNETONKA",
"state": "MN",
"postal_code": "55305",
"telephone_number": "763-260-1469"
}
],
"practiceLocations": [
{
"address_1": "229 E Saint George Blvd Ste 105",
"address_purpose": "LOCATION",
"city": "St George",
"state": "UT",
"postal_code": "847707902",
"country_code": "US",
"telephone_number": "435-674-1926",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VRADENBURG",
"first_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-29",
"last_updated": "2024-10-01",
"certification_date": "2024-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "UT",
"license": "11698237-8007",
"primary": false
},
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "7187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minnetonka, MN
- Volunteers of America MN (Children's REsidential Treatment Center)
- Julia Vongphachanh
- Barry Voroba, PH.D.
- Jeanette Laverne Vought, PHD, LP
- Kelly Vourlos, MSW, LICSW
- Carmen Lynn Vriezema, AC/ AGPCNP-BC
- Sarah Marie Waech
- William Walton Wagnild, DDS
- Samantha Andrea Wakefield, FNP-BC
- Brittany Alisha Ann Wakem Mottram
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.