Individual provider Active NPI

Jodi Lynn Fidler, D.C.

  • Chiropractor
  • Saint Louis Park, MN
National Provider Identifier
1376687657
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3273 Issued in MN
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

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 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

LicenseStateTypeSpecialty
3273MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew 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.

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.

Verify at the official NPI Registry.