Northern Roots Family Spinal Care, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

NORTHERN ROOTS FAMILY SPINAL CARE, LLC

Practice address

470 3Rd Ave
Clear Lake, WI 54005

Phone

(715) 303-7121

NPI assigned

Aug 12, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Chase Brendan O'Keefe, DCNPI 1376095984

Title

Chief Manager

Phone

(715) 563-7447

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

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

• Chase Brendan O'Keefe, D.C.

  • Chiropractor
  • Stillwater, MN
  • NPI 1376095984

  WI

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565568000000",
    "number": "1043866460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2389 US HIGHWAY 63",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "540057702",
            "telephone_number": "715-563-7447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 3RD AVE",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "54005",
            "telephone_number": "715-303-7121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ROOTS FAMILY SPINAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A",
        "authorized_official_last_name": "O'KEEFE",
        "authorized_official_first_name": "CHASE",
        "authorized_official_middle_name": "BRENDAN",
        "authorized_official_title_or_position": "CHIEF MANAGER",
        "authorized_official_telephone_number": "715-563-7447",
        "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": []
}

• Kathy Ann Gates, FNP-C
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• Kyle Anthony Larson, DPT
• Emily J Monson, MSPT
• Jolleen Mary Nichols, DNP
• Northland Audiology LLC
• Paulson Chiropractic Clinic, LLC
• Bradley Alvin Paulson, DC
• Brent Richard Paulson, D.C.
• School District of Clear Lake

• Chiropractor in Clear Lake, WI
• Providers in Clear Lake, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.