Individual provider Active NPI

Troy Dale Knewtson, DC

  • Chiropractor
  • Excelsior, MN
National Provider Identifier
1215947460
Registry record updated Sep 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3873 Issued in MN
Practice address
23505 Smithtown Rd
Suite 100
Excelsior, MN 55331-4541
Phone
(952) 470-8555
Fax
(952) 401-8785
NPI assigned
Aug 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3873 MN Primary

Addresses

Primary practice location

23505 Smithtown Rd
Suite 100
Excelsior, MN 55331-4541

Mailing address

23505 Smithtown Rd
Suite 100
Excelsior, MN 55331-4541
Phone (952) 470-8555

Other identifiers 1

IdentifierTypeStateIssuer
549157600MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111214000988 MN Practitioner - Chiropractic 9234188905 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Knewtson Family Chiropractic PAGroup PAC ID 3779532593, 8 clinicians

Practice addresses (Care Compare)

23505 Smithtown Rd
Excelsior, MN 55331-4541
Phone (952) 470-8555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3873MNMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Knewtson Family Chiropractic PA Chiropractor CurrentSince Feb 1, 2000 Accepting new patients

Locations

23505 Smithtown Rd
Shorewood, MN 55331
Phone (952) 470-8555

23505 Smithtown Rd
Ste 100
Shorewood, MN 55331
Phone (952) 426-0874

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1215947460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23505 SMITHTOWN RD",
            "address_2": "SUITE 100",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553314541",
            "telephone_number": "952-470-8555",
            "fax_number": "952-401-8785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23505 SMITHTOWN RD",
            "address_2": "SUITE 100",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553314541",
            "telephone_number": "952-470-8555",
            "fax_number": "952-401-8785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNEWTSON",
        "first_name": "TROY",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3873",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "549157600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Excelsior, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.