Active NPI
Jodi Lynn Fidler, D.C.
- Chiropractor
- Saint Louis Park, MN
National Provider Identifier
1376687657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3273
- Practice address
- 4415 Excelsior Blvd
Saint Louis Park, MN 55416-4813 - Phone
- (952) 925-4085
- Fax
- (952) 925-1394
- NPI assigned
- Feb 19, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3273 | MN | Primary |
Addresses
Primary practice location
4415 Excelsior Blvd
Saint Louis Park, MN 55416-4813
Mailing address
4415 Excelsior Blvd
Saint Louis Park, MN 55416-4813
Phone (952) 925-4085
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3273 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SLP Chiropractic, PA | Chiropractor | Past | Accepting new patients |
| Nielson Family Chiropractic PLLC | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Chiropractor
- St Louis Park, MN
- NPI 1467736231
-
- Chiropractor
- Saint Louis Park, MN
- NPI 1568661601
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1376687657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4415 EXCELSIOR BLVD",
"city": "SAINT LOUIS PARK",
"state": "MN",
"postal_code": "554164813",
"telephone_number": "952-925-4085",
"fax_number": "952-925-1394"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4415 EXCELSIOR BLVD",
"city": "SAINT LOUIS PARK",
"state": "MN",
"postal_code": "554164813",
"telephone_number": "952-925-4085",
"fax_number": "952-925-1394"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIDLER",
"first_name": "JODI",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "3273",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Louis 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.