Mitchell Alan Brecke, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5854 Issued in MN

Practice address

5480 Nathan Lane North
Suite 102
Plymouth, MN 55442-1868

Phone

(763) 316-5252

Fax

(763) 316-5253

NPI assigned

Mar 18, 2014

Last updated

May 19, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2013

Medicare assignment

May accept Medicare assignment

Group practices

Northern Edge Chiropractic LLCGroup PAC ID 0345463741, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Northern Edge Chiropractic LLC

  • Chiropractor
  • Plymouth, MN
  • NPI 1033521927
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1395100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400457600000",
    "number": "1083031843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5480 NATHAN LANE NORTH",
            "address_2": "SUITE 102",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421868",
            "telephone_number": "763-316-5252",
            "fax_number": "763-316-5253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5480 NATHAN LANE NORTH",
            "address_2": "SUITE 102",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554421868",
            "telephone_number": "763-316-5252",
            "fax_number": "763-316-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRECKE",
        "first_name": "MITCHELL",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-18",
        "last_updated": "2014-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corbin Boyd, PHARMD
• Jennifer L Brandenburg, PHARMD
• Monica Marie Brands, RPH
• Natalie Brandsrud, CNP
• Jennifer A Bratvold, RPH
• Melissa Lynn Bredemus, APRN, CNP
• Marshall O Breneman, PA
• Elizabeth Ann Brennan, PMHNP
• Brent Cataldo DDS PA
• Courtney Caryl Breyer, MA, LADC, LPCC

• Chiropractor in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.