Active NPI
Paul Eugene Undersander, DC
- Chiropractor
- Saint Cloud, MN
National Provider Identifier
1063592640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 2974
- Practice address
- 251 County Road 120
Suite B
Saint Cloud, MN 56303-4872 - Phone
- (320) 252-3711
- Fax
- (320) 240-0608
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2974 | MN | Primary |
Addresses
Primary practice location
251 County Road 120
Suite B
Saint Cloud, MN 56303-4872
Mailing address
251 County Road 120
Suite B
Saint Cloud, MN 56303-4872
Phone (320) 252-3711
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 670028400 | Medicaid | MN |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304640000000",
"number": "1063592640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "251 COUNTY ROAD 120",
"address_2": "SUITE B",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563034872",
"telephone_number": "320-252-3711",
"fax_number": "320-240-0608"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 COUNTY ROAD 120",
"address_2": "SUITE B",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563034872",
"telephone_number": "320-252-3711",
"fax_number": "320-240-0608"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERSANDER",
"first_name": "PAUL",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2011-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "2974",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "670028400",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.