Active NPI
Connie Theisen
- Chiropractor
- Maple Grove, MN
National Provider Identifier
1063599892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- DC4091
- Practice address
- 9479 Garland Ave
Maple Grove, MN 55311-5480 - Phone
- (763) 494-8787
- NPI assigned
- Nov 1, 2006
- Last updated
- Sep 3, 2008
- Sex
- Female
- 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 | DC4091 | MN | Primary |
Addresses
Primary practice location
9479 Garland Ave
Maple Grove, MN 55311-5480
Mailing address
12748 Walter Dr
Rogers, MN 55374-5822
Phone (763) 360-2405
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 44-00217 | Other | MN | MEDICA |
| 078K2HE | Other | MN | BCBS MN |
| 065473600 | Other | MN | MN STATE AID |
| 112377 | Other | MN | HEALTH PARTNERS |
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 |
|---|---|---|---|
| DC4091 | MN | MD | Chiropractor |
| 4091 | MN | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nord Chiropractic, P.a. | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220400000000",
"number": "1063599892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12748 WALTER DR",
"city": "ROGERS",
"state": "MN",
"postal_code": "553745822",
"telephone_number": "763-360-2405"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9479 GARLAND AVE",
"city": "MAPLE GROVE",
"state": "MN",
"postal_code": "553115480",
"telephone_number": "763-494-8787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEISEN",
"first_name": "CONNIE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2008-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "DC4091",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "44-00217",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MN",
"identifier": "078K2HE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MN STATE AID",
"identifier": "065473600",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS",
"identifier": "112377",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maple Grove, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.