Revolution Chiropractic Wellness Center PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5016 Issued in MN

Legal business name

REVOLUTION CHIROPRACTIC WELLNESS CENTER PLLC

Practice address

8509 Jefferson LN N
Brooklyn Park, MN 55445-2119

Phone

(763) 425-4577

Fax

(763) 425-2676

NPI assigned

Dec 11, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Suzanne M Holmes, DC

Title

Owner

Phone

(763) 425-4577

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

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

• Celia Marie McDougle, DC

  • Chiropractor
  • Brooklyn Park, MN
  • NPI 1508385709
  NPD
• Jenna Renee Smaby, D.C.

  • Chiropractor
  • Grand Forks, ND
  • NPI 1265773519
  NPD
• Meghan Shogren Birt, D.C

  • Chiropractor
  • Brooklyn Park, MN
  • NPI 1124314406
  NPD (past)

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

{
    "created_epoch": "1228953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451347200000",
    "number": "1275778763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8509 JEFFERSON LN N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452119",
            "telephone_number": "763-425-4577",
            "fax_number": "763-425-2676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8509 JEFFERSON LN N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452119",
            "telephone_number": "763-425-4577",
            "fax_number": "763-425-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION CHIROPRACTIC WELLNESS CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-11",
        "last_updated": "2015-12-29",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-425-4577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL NPI FOR SUZANNE HOLMES DC",
            "identifier": "1093961385",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Brooklyn Park, MN
• Providers in Brooklyn Park, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.