Individual provider Active NPI

Katie Jo Klundt, DC

  • Chiropractor
  • Edina, MN
National Provider Identifier
1376204479
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6936 Issued in MN
Practice address
3948 W 50TH St Ste 203
Edina, MN 55424-1253
Phone
(952) 920-4528
NPI assigned
Jan 2, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6936 MN Primary

Addresses

Primary practice location

3948 W 50TH St Ste 203
Edina, MN 55424-1253

Mailing address

15551 Dunraven Dr
Apple Valley, MN 55124-7838
Phone (952) 920-4528

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220418001541 MN Practitioner - Chiropractic 9830586049 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Traditionally HealthyGroup PAC ID 2567689169, 2 clinicians

Practice addresses (Care Compare)

1121 Jackson St NE
Suite 119
Minneapolis, MN 55413-1597
Phone (612) 382-7408

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6936MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
50TH & France Chiropractic & Wellness PLLC Chiropractor CurrentSince Jan 17, 2022 Accepting new patients
Traditionally Healthy Chiropractor CurrentSince Apr 1, 2022 Accepting new patients
Jo & Clark Chiropractic, P.a. Chiropractor PastSince Jan 17, 2022 Accepting new patients

Locations

1121 Jackson St NE
Ste 119
Minneapolis, MN 55413
Phone (612) 382-7408

3948 W 50th St
Ste 203
Minneapolis, MN 55424
Phone (952) 920-4528

Organizations & group practices 3

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": "1641081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1376204479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15551 DUNRAVEN DR",
            "city": "APPLE VALLEY",
            "state": "MN",
            "postal_code": "551247838",
            "telephone_number": "952-920-4528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3948 W 50TH ST STE 203",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554241253",
            "telephone_number": "952-920-4528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLUNDT",
        "first_name": "KATIE",
        "middle_name": "JO",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-02",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; 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.