Premier Health of Plymouth LTD

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5191 Issued in MN

Legal business name

PREMIER HEALTH OF PLYMOUTH LTD

Doing business as

Premier Health of Golden Valley

Practice address

5801 Duluth St Ste 345
Golden Valley, MN 55422-3952

Phone

(763) 354-7880

Fax

(763) 354-7882

NPI assigned

Aug 30, 2011

Last updated

Nov 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian David Chmiel, DCNPI 1306170618

Title

Owner

Phone

(763) 354-7880

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Premier Health of Golden Valley Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 3

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.

• Brian David Chmiel, D.C.

  • Chiropractor
  • Falcon Heights, MN
  • NPI 1306170618
  Medicare reassignment NPD Authorized official
• Yamaris Grisselle Lopez

  • Chiropractor
  • Golden Valley, MN
  • NPI 1497454003
  NPD
• Larry Lee Estebo, D.C.

  • Orthopedic Chiropractor
  • Falcon Heights, MN
  • NPI 1285766352
  NPD (past)

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

{
    "created_epoch": "1314662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1205117678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5801 DULUTH ST STE 345",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223952",
            "telephone_number": "763-354-7880",
            "fax_number": "763-354-7882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 DULUTH ST STE 345",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223952",
            "telephone_number": "763-354-7880",
            "fax_number": "763-354-7882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER HEALTH OF PLYMOUTH LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-30",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "CHMIEL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-354-7880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306170618",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR MANAGING DOCTOR",
            "identifier": "1306170618",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1306170618",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Health of Golden Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; 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.