Mark Alan Pederson, DC
Individual provider Active NPI Chiropractor · Warren, MN
NPI 1215045604 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215045604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3351 (MN)
- Practice address
- 603 N Main Street
Warren, MN 56762 - Phone
- (218) 745-6655
- Fax
- (218) 745-4049
- NPI assigned
- Aug 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3351 | MN | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Regenerative Medicine Center PC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3351 | MN | Yes |
Addresses
Primary practice location
603 N Main Street
Warren, MN 56762
Mailing address
603 N Main Street
Warren, MN 56762
Phone (218) 745-6655
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20215 | Other | ND | BCBS |
| 15F41PE | Other | MN | BCBS |
Other providers in Warren, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.