Functional Chiropractic Rehab, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FUNCTIONAL CHIROPRACTIC REHAB, PLLC

Practice address

1901 Madison Ave Ste 120
Mankato, MN 56001-6267

Phone

(605) 380-4364

NPI assigned

Mar 14, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin Martin Hansen

Title

Owner

Phone

(605) 380-4364

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1584144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585699200000",
    "number": "1073149779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 MADISON AVE STE 120",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016267",
            "telephone_number": "605-380-4364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MADISON AVE STE 120",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560016267",
            "telephone_number": "605-380-4364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNCTIONAL CHIROPRACTIC REHAB, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-14",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-380-4364",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL PROVIDER IDENTIFIER",
            "identifier": "1326676412",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandra Annmarie Freitag
• Joann Patrice Frey Hawkins, LP
• Edward A Frey, MS, LPC
• Julie Freyberg, CNP
• Riley Marie Fritz
• Megumi Furuta
• Fussy Chiropractic Health and Wellness PLLC
• Brittany Christina Fussy, DC
• Tammy M Gagnon, MSW, LICSW
• Charlotte Eileen Gallagher, LIC. ACUPUNCTURIST

• Clinic/Center in Mankato, MN
• Providers in Mankato, MN by specialty
• Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; 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.