Michael John Modich, D.C.
Individual provider Active NPI Chiropractor · Side Lake, MN
NPI 1114237013 · NPPES record last updated Oct 14, 2010
Key facts
- NPI
- 1114237013
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5322 (MN)
- Practice address
- 7636 Pine Tree Rd
Side Lake, MN 55781-8441 - Phone
- (218) 969-4928
- NPI assigned
- Oct 14, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Range Spine Center, PLLC
Practice addresses (Care Compare)
4104 - 9TH Ave W
Hibbing, MN 55746-3020
Phone (218) 263-8330
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130409000169 | MN | Practitioner - Chiropractic | 5597919027 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5322 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Range Spine Center, PLLC | Chiropractor | Current |
Accepting new patients |
Locations
4104 9th Ave W
Hibbing, MN 55746
Phone (218) 263-8330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 5322 | MN | Yes |
Addresses
Primary practice location
7636 Pine Tree Rd
Side Lake, MN 55781-8441
Mailing address
7636 Pine Tree Rd
Side Lake, MN 55781-8441
Phone (218) 969-4928
Other providers in Side Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.