DMR Clinic Rogers LLC
Organization Active NPI Chiropractor · Otsego, MN
NPI 1356892285 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1356892285
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- 5257 (MN)
- Legal business name
- DMR CLINIC ROGERS LLC
- Practice address
- 9000 Quantrelle Ave NE Ste 240
Otsego, MN 55330-1022 - Phone
- (763) 432-9866
- NPI assigned
- Oct 15, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Michlynn Heide, D.C.
- Title
- Chiropractor
- Phone
- (612) 670-9026
Practitioners 6
-
Michlynn Rae Heide, D.C.
-
Kelley M McGowan, PT
-
Jo Ellen Torola, MASSAGE THERAPIST
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170317001764 | MN | Part B Supplier - Clinic/Group Practice | 4082999818 |
Receives reassigned benefits from 3 practitioners Practice locations: Otsego, MN |
National Provider Directory
Locations
9000 Quantrelle Ave NE
Ste 240
Otsego, MN 55330
Phone (612) 432-9866
13690 Rogers Dr
Ste 180
Rogers, MN 55374
Phone (612) 670-9026
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | 5257 | MN | Yes |
Addresses
Primary practice location
9000 Quantrelle Ave NE Ste 240
Otsego, MN 55330-1022
Mailing address
9000 Quantrelle Ave NE Ste 240
Otsego, MN 55330-1022
Phone (763) 432-9866
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 350004449 | Other | MN | MEDICARE ID |
Other names
- Ripple Health Clinic
Other providers in Otsego, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.