Individual provider Active NPI

Chad Alan Clementson, D.C.

  • Chiropractor
  • Brooklyn Park, MN
National Provider Identifier
1346358488
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3810 Issued in MN
Practice address
6800 78TH Ave N
Suite 107
Brooklyn Park, MN 55445-2758
Phone
(763) 566-1042
Fax
(763) 566-8090
NPI assigned
Aug 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3810 MN Primary

Addresses

Primary practice location

6800 78TH Ave N
Suite 107
Brooklyn Park, MN 55445-2758

Mailing address

6800 78TH Ave N
Suite 107
Brooklyn Park, MN 55445-2758
Phone (763) 566-1042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111129000614 MN Practitioner - Chiropractic 3476727520 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brook West Chiropractic Clinic, PLLCGroup PAC ID 1254505027, 3 clinicians

Practice addresses (Care Compare)

6800 78TH Ave N
Suite 107
Brooklyn Park, MN 55445-2758
Phone (763) 566-1042

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Brook West Chiropractic Clinic, PLLC Chiropractor CurrentSince Sep 1, 1999 Accepting new patients

Locations

6800 78th Ave N
Ste 107
Minneapolis, MN 55445
Phone (763) 566-1042

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346358488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 78TH AVE N",
            "address_2": "SUITE 107",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452758",
            "telephone_number": "763-566-1042",
            "fax_number": "763-566-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 78TH AVE N",
            "address_2": "SUITE 107",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452758",
            "telephone_number": "763-566-1042",
            "fax_number": "763-566-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENTSON",
        "first_name": "CHAD",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.