Vitality Chiropractic P.a.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4890 Issued in MN

Legal business name

VITALITY CHIROPRACTIC P.A.

Doing business as

Bemidji Family Chiropractic Center

Practice address

5184 Theater Lane NW
Bemidji, MN 56601

Phone

(218) 751-8099

NPI assigned

Jan 10, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Matthew John Henriksen, D.C.NPI 1891842589

Title

President

Phone

(218) 751-8099

Specialties & licenses 1

Addresses

Other names 1

• Bemidji Family Chiropractic Center Doing business as

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.

• Matthew John Henriksen, D.C

  • Chiropractor
  • Bemidji, MN
  • NPI 1891842589
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205985710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 875",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566190875",
            "telephone_number": "218-751-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5184 THEATER LANE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "56601",
            "telephone_number": "218-751-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY CHIROPRACTIC P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HENRIKSEN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "218-751-8099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bemidji Family Chiropractic Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gwen Marie Verchota, FNP
• Marina Jennifer Verke, RN
• Vicki Lynn Roff (Northwest C&TC Clinic)
• Hannah Moussa Vines, MD
• Vision Optical Inc
• Bryna Vonholdt, FNP
• Voyageurs Expeditionary School
• Benjamin R Waddell, DO
• Jia Wagar, LPCC
• James S Wagner, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.