Paul Jeffrey Dettling, D.C.

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

6125 Issued in MN

Practice address

615 66TH Ave N
Brooklyn Center, MN 55430-1667

Phone

(763) 560-8980

NPI assigned

Sep 1, 2015

Last updated

Sep 1, 2015By 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

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dettling Chiropractic Rehab and Performance PLLCGroup PAC ID 7416263454, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Dettling Chiropractic Rehab and Performance PLLC

  • Chiropractor
  • Brooklyn Center, MN
  • NPI 1083081418
  Medicare reassignment Care Compare group NPD Authorized official
• Carlson Healthcare LLC

  • Chiropractor
  • Brooklyn Center, MN
  • NPI 1578860565
  NPD (past)
• MJ Chiropractic

  dba Bloom Lake Chiropractic

  • Chiropractor
  • Minneapolis, MN
  • NPI 1992909998
  NPD (past)

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441065600000",
    "number": "1306213798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 66TH AVE N STE 2",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554301666",
            "telephone_number": "763-560-8980",
            "fax_number": "763-560-0611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 66TH AVE N",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554301667",
            "telephone_number": "763-560-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTLING",
        "first_name": "PAUL",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-01",
        "last_updated": "2015-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "MN",
            "license": "6125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Consultants LLC (Aspen Dental)
• Dental Specialists of Minnesota, PLLC (The Dental Specialists)
• Mark Depaolis, MD
• Beth Anne Despiegelaere, OD
• Dettling Chiropractic Rehab and Performance PLLC
• Stephanie Ann Devine, RPH
• Dialleh Services, LLC
• Kadiatou Diallo
• Stephanie Diaz Casco
• Armando Diaz

• Sports Physician Chiropractor in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Sports Physician Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.