Spine and Sport Chiropractic

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1462 Issued in MN

Legal business name

SPINE AND SPORT CHIROPRACTIC

Practice address

1058 Curve Crest Blvd W
Stillwater, MN 55082-6056

Phone

(651) 439-6500

Fax

(651) 439-6501

NPI assigned

May 18, 2007

Organization subpart

No

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

Authorized official

Name

Darrick A Dierkhising, D.C.NPI 1013019553

Title

Owner

Phone

(651) 439-6500

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• R.E. Kranz Chiropractic Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

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

• Darrick A Dierkhising, D.C.

  • Chiropractor
  • Stillwater, MN
  • NPI 1013019553
  Medicare reassignment Care Compare group NPD Authorized official
• Justin Smith, DC, LAT

  • Chiropractor
  • Stillwater, MN
  • NPI 1841678281
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557273600000",
    "number": "1255549705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 CURVE CREST BLVD W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826056",
            "telephone_number": "651-439-6500",
            "fax_number": "651-439-6501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 CURVE CREST BLVD W",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826056",
            "telephone_number": "651-439-6500",
            "fax_number": "651-439-6501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND SPORT CHIROPRACTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2019-05-08",
        "status": "A",
        "authorized_official_last_name": "DIERKHISING",
        "authorized_official_first_name": "DARRICK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-439-6500",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "1462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7600275",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "R.E. Kranz Chiropractic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "R.E. Kranz Chiropractic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kate Walsh Soucheray, LMFT
• Nicholas Moore Southerton, MSN, CNP
• Southside Community Health Services, Inc.
• Steven Duane Spandl
• Spinal Care One, PA
• Shelley L Spitzer, OTR
• Sandra Lea Spore, RN DC DABCI DACBN
• St Croix Drug Company
• St Croix Oral, Maxillofacial & Implant Surgery, P.a.
• St Croix Vision Center Inc.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2019; 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.