Cottage Grove Chiropractic Clinic, PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1398 Issued in MN

Legal business name

COTTAGE GROVE CHIROPRACTIC CLINIC, PA

Practice address

7702 80TH St S
Cottage Grove, MN 55016-3194

Phone

(651) 459-0066

Fax

(651) 459-8005

NPI assigned

Oct 27, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Susan D Delcastillo, DC

Title

Owner

Phone

(651) 459-0066

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1256601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256601600000",
    "number": "1366778243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7702 80TH ST S",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550163194",
            "telephone_number": "651-459-0066",
            "fax_number": "651-459-8005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7702 80TH ST S",
            "city": "COTTAGE GROVE",
            "state": "MN",
            "postal_code": "550163194",
            "telephone_number": "651-459-0066",
            "fax_number": "651-459-8005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTAGE GROVE CHIROPRACTIC CLINIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-27",
        "last_updated": "2009-10-27",
        "status": "A",
        "authorized_official_last_name": "DELCASTILLO",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-459-0066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "1398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "56037CO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "995227600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "4576",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN",
            "identifier": "230556",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Cottage Grove
• Casandra Jewel Clark
• Comfortcare Services Co
• Consilon
• Ann R Cook, BA, LADC
• Cottage Grove Smiles Dentistry, PC
• Cottage Grove WP, LLC
• Jodi J Cowan, LPC
• Sarah Crandall, L.M.T.
• Diane Vavrik Crater, DDS

• Chiropractor in Cottage Grove, MN
• Providers in Cottage Grove, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; 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.