Birch Lake Chiropractic Clinic, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

751 Issued in MN

Legal business name

BIRCH LAKE CHIROPRACTIC CLINIC, LLC

Practice address

4635 White Bear Pkwy
White Bear Lake, MN 55110-3300

Phone

(651) 429-5329

Fax

(651) 429-2759

NPI assigned

Nov 24, 2006

Organization subpart

No

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

• Grant Erickson, D.C.

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1932275815
  Medicare reassignment NPD Authorized official
• Kimberley M Mintell, DC

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1558542530
  NPD (past)
• James G Mondo, D.C.

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1891887451
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

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

Authorized official

Name

Dr. Grant Erickson, D.C.NPI 1932275815

Title

Owner

Phone

(651) 429-5329

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1255407136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4635 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103300",
            "telephone_number": "651-429-5329",
            "fax_number": "651-429-2759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4635 WHITE BEAR PKWY",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103300",
            "telephone_number": "651-429-5329",
            "fax_number": "651-429-2759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIRCH LAKE CHIROPRACTIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "GRANT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-429-5329",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - CLINIC #",
            "identifier": "273GOBI",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "231600",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHCP",
            "identifier": "6763511-00",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fernando Benitez
• Cascia Berman
• Monica Beulke
• Mulatu Geleto Bino
• Birch Behavioral Medicine, PLLC
• Birch Lake Dental
• Birch Lake Dental PA
• Birch Lake Professional Counseling Group, Inc.
• Birch Lake Vision Group, LLC.
• Ami Bischel

• All providers in White Bear Lake, MN
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.