NPIMap

Organization Active NPI

Red Wing Chiropractic Clinic PA

  • Chiropractor
  • Red Wing, MN
National Provider Identifier
1306949797
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
166 Issued in MN
Legal business name
RED WING CHIROPRACTIC CLINIC PA
Practice address
29218 Highway 58 Blvd
Red Wing, MN 55066-7407
Phone
(651) 388-8294
Fax
(651) 388-7461
NPI assigned
Sep 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jay Melvin Greenberg, DC
Title
President
Phone
(651) 388-8294

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 166 MN Primary

Addresses

Primary practice location

29218 Highway 58 Blvd
Red Wing, MN 55066-7407

Mailing address

29218 Highway 58 Blvd
Red Wing, MN 55066-7407
Phone (651) 388-8294

Other identifiers 1

IdentifierTypeStateIssuer
31374REOtherBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306949797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29218 HIGHWAY 58 BLVD",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550667407",
            "telephone_number": "651-388-8294",
            "fax_number": "651-388-7461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29218 HIGHWAY 58 BLVD",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "550667407",
            "telephone_number": "651-388-8294",
            "fax_number": "651-388-7461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED WING CHIROPRACTIC CLINIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREENBERG",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "MELVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-388-8294",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "31374RE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Wing, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.