John Wayne Samuelson, DC

Primary specialty

Orthopedic ChiropractorTaxonomy code 111NX0800X

License

1626 Issued in MN

Practice address

13 W 2ND Ave N
Aurora, MN 55705-1313

Phone

(218) 229-3638

Fax

(218) 229-2661

NPI assigned

Oct 25, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1275617128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 W 2ND AVE N",
            "city": "AURORA",
            "state": "MN",
            "postal_code": "557051313",
            "telephone_number": "218-229-3638",
            "fax_number": "218-229-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 W 2ND AVE N",
            "city": "AURORA",
            "state": "MN",
            "postal_code": "557051313",
            "telephone_number": "218-229-3638",
            "fax_number": "218-229-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELSON",
        "first_name": "JOHN",
        "middle_name": "WAYNE",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Orthopedic",
            "state": "MN",
            "license": "1626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROCARE",
            "identifier": "230743",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "69716SA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Aurora, MN by specialty
• Orthopedic Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.