Healthsource of White Bear Lake, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5114 Issued in MN

Legal business name

HEALTHSOURCE OF WHITE BEAR LAKE, PLLC

Practice address

4801 Highway 61 N
105
White Bear Lake, MN 55110-2737

Phone

(651) 762-5433

Fax

(651) 762-7504

NPI assigned

Nov 13, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Michael Leo Dixon, DCNPI 1174686570

Title

Chiropractor

Phone

(651) 762-5433

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 6

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

• Ty Evan Paulick, D.C.

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1902071285
  Medicare reassignment NPD
• Michael L. Dixon, DC

  • Chiropractor
  • Saint Paul, MN
  • NPI 1174686570
  NPD (past) Authorized official
• Bo Wesley Greig, D.C.

  • Chiropractor
  • Elk River, MN
  • NPI 1689945156
  NPD (past)
• Lee Schwartz, D.C.

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1306992011
  NPD (past)
• John Michael Leo Tomlinson, DC

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1336312339
  NPD (past)
• Jamie L Cortese, D.C.

  • Chiropractor
  • Hudson, WI
  • NPI 1578885307
  NPD (past)

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

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1073767372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 HIGHWAY 61 N",
            "address_2": "105",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102737",
            "telephone_number": "651-762-5433",
            "fax_number": "651-762-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 HIGHWAY 61 N",
            "address_2": "105",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102737",
            "telephone_number": "651-762-5433",
            "fax_number": "651-762-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF WHITE BEAR LAKE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-13",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "DIXON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LEO",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "651-762-5433",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5114",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeanne Marie Hartle
• Samiyo Abdiaziz Hassan
• Gerald D. Hautman, M.D.
• Derartu Fessa Hayato
• Healthcorps, Inc.
• Maria Isabella Heaney, MA, LPCC
• Iris Heieren, MA, LAMFT
• Helix Chiropractic PA
• Liana Marie Hermann
• Samantha Herme

• Chiropractor in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.