Blackduck Chiropractic, LLC
Organization Active NPI Chiropractor · Blackduck, MN
NPI 1114465366 · NPPES record last updated Jan 18, 2024
Key facts
- NPI
- 1114465366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 6315 (MN)
- Legal business name
- BLACKDUCK CHIROPRACTIC, LLC
- Practice address
- 22388 Blackduck Lake Rd NE
Blackduck, MN 56630-4226 - Phone
- (218) 835-8837
- NPI assigned
- Feb 8, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Heather Christine Tjepkes, DC
- Title
- Owner
- Phone
- (218) 835-8837
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170314000046 | MN | Part B Supplier - Clinic/Group Practice | 6800171810 |
Receives reassigned benefits from 1 practitioner Practice locations: Blackduck, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 6315 | MN | Yes |
Addresses
Primary practice location
22388 Blackduck Lake Rd NE
Blackduck, MN 56630-4226
Mailing address
22388 Blackduck Lake Rd NE
Blackduck, MN 56630-4226
Other providers in Blackduck, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.