Healthsource of Minnetonka LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5624 Issued in MN

Legal business name

HEALTHSOURCE OF MINNETONKA LLC

Practice address

14413 Excelsior Blvd
Minnetonka, MN 55345-5821

Phone

(952) 746-1506

NPI assigned

Aug 31, 2015

Organization subpart

No

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

Authorized official

Name

Derek Anderson, DCNPI 1770884546

Title

Owner

Phone

(952) 746-1506

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Derek Steven Anderson, D.C.

  • Chiropractor
  • Minnetonka, MN
  • NPI 1770884546
  Medicare reassignment Care Compare group NPD Authorized official
• Logan Tomasek, DC

  • Chiropractor
  • Minnetonka, MN
  • NPI 1457177834
  Medicare reassignment Care Compare group NPD
• Julie Hauring, DC

  • Chiropractor
  • Hopkins, MN
  • NPI 1659879260
  Medicare reassignment NPD
• Tyler Riesgraf, DC

  • Chiropractor
  • Minnetonka, MN
  • NPI 1083129514
  Medicare reassignment NPD

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

{
    "created_epoch": "1440979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440979200000",
    "number": "1164899795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14413 EXCELSIOR BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14413 EXCELSIOR BLVD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553455821",
            "telephone_number": "952-746-1506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF MINNETONKA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-31",
        "last_updated": "2015-08-31",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-746-1506",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Gerard Hayes, DC
• Jacob P. Hayman, MD
• Hcri Sun III Tenant, LP
• HD Corp
• Healthemed, Inc.
• Healthsource Solutions
• Healthy Soles Inc.
• Brooke Marie Heaney, OTR/L
• Hearing Solutions Group
• Hearthside Care LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2015; 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.