Crow Wing Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5700 Issued in MN

Legal business name

CROW WING CHIROPRACTIC PC

Practice address

15229 Edgewood Dr Ste 125
Baxter, MN 56401-6920

Phone

(218) 205-1908

NPI assigned

Apr 16, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jedediah Moore, D.C.NPI 1811246192

Title

Chiropractor

Phone

(218) 205-1908

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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.

• Jedediah Moore, D.C.

  • Chiropractor
  • Elk River, MN
  • NPI 1811246192
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1397606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401840000000",
    "number": "1154741288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15229 EDGEWOOD DR STE 125",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "56425",
            "telephone_number": "218-454-2840",
            "fax_number": "218-454-2841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15229 EDGEWOOD DR STE 125",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564016920",
            "telephone_number": "218-205-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROW WING CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-16",
        "last_updated": "2014-06-04",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "JEDEDIAH",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "218-205-1908",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Troy D Couture
• Alexis Ignacia Coventry
• Amanda R Cowan-Nelson
• Kaylei Rae Cox
• Bridget Rae Crabtree, LPC
• Crow Wing Wellness LLC
• Lindsay Berk Cure-Hendrickson, LADC
• Emalee Ann Davey
• David C. Anderholm, MD, PA (Northern Psychiatric Associates)
• Melissa Dawn Davidson, MOTR/L

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.