NPIMap

Organization Active NPI

Eagle Creek Chiropractic

  • Physical Therapist
  • Prior Lake, MN
National Provider Identifier
1073847554
Registry record updated Sep 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6755 Issued in MN
Legal business name
EAGLE CREEK CHIROPRACTIC
Practice address
14180 Commerce Ave NE
Prior Lake, MN 55372-1483
Phone
(952) 447-3395
Fax
(952) 447-3396
NPI assigned
Sep 30, 2009
Last updated
Sep 30, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
EAGLE CREEK CHIROPRACTICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2009

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

Authorized official

Name
Jenna Kanitz
Title
Office Manager
Phone
(952) 447-3395

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5996 MN
Physical Therapist 225100000X 6755 MN Primary

Addresses

Primary practice location

14180 Commerce Ave NE
Prior Lake, MN 55372-1483

Mailing address

14180 Commerce Ave NE
Prior Lake, MN 55372-1483
Phone (952) 447-3395

Other names 1

  • Eagle Creek Wellness Center Other name

National Provider Directory

National Provider Directory
Part of
Eagle Creek Chiropractic

Locations

14180 Commerce Ave NE
Prior Lake, MN 55372
Phone (952) 447-3395

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1254268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254268800000",
    "number": "1073847554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14180 COMMERCE AVE NE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721483",
            "telephone_number": "952-447-3395",
            "fax_number": "952-447-3396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14180 COMMERCE AVE NE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721483",
            "telephone_number": "952-447-3395",
            "fax_number": "952-447-3396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE CREEK CHIROPRACTIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EAGLE CREEK CHIROPRACTIC",
        "enumeration_date": "2009-09-30",
        "last_updated": "2009-09-30",
        "status": "A",
        "authorized_official_last_name": "KANITZ",
        "authorized_official_first_name": "JENNA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "952-447-3395"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "5996",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "6755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Creek Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Prior Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2009; 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.