Active NPI
Dennis Robert Brummond, CHIROPRACTOR
- Chiropractor
- Stillwater, MN
National Provider Identifier
1114199247
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3905
- Practice address
- 6750 Stillwater Blvd N
Stillwater, MN 55082-5485 - Phone
- (651) 439-2004
- Fax
- (651) 689-1636
- NPI assigned
- Mar 28, 2008
- Sex
- Male
- 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 | 3905 | MN | Primary |
Addresses
Primary practice location
6750 Stillwater Blvd N
Stillwater, MN 55082-5485
Mailing address
6750 Stillwater Blvd N
Stillwater, MN 55082-5485
Phone (651) 439-2004
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 |
|---|---|---|---|
| 3905 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Back to Life Chiropractic PC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Stillwater, MN
- NPI 1245440502
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206662400000",
"number": "1114199247",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6750 STILLWATER BLVD N",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550825485",
"telephone_number": "651-439-2004",
"fax_number": "651-689-1636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6750 STILLWATER BLVD N",
"city": "STILLWATER",
"state": "MN",
"postal_code": "550825485",
"telephone_number": "651-439-2004",
"fax_number": "651-689-1636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUMMOND",
"first_name": "DENNIS",
"middle_name": "ROBERT",
"credential": "CHIROPRACTOR",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-03-28",
"last_updated": "2008-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "3905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stillwater, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.