Timothy Jon Vaagenes Sr., D.C.
Individual provider Active NPI Chiropractor · North Oaks, MN
NPI 1376697102 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1376697102
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 3144 (MN)
- Practice address
- 200 Village Center Dr
Suite 100
North Oaks, MN 55127-7090 - Phone
- (651) 415-0446
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
119 Lake St S
Mora, MN 55051-1577
Phone (320) 679-5800
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031208000679 | MN | Practitioner - Chiropractic | 1658277132 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3144 | MN | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Step Therapies, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3144 | MN | Yes |
Addresses
Primary practice location
200 Village Center Dr
Suite 100
North Oaks, MN 55127-7090
Mailing address
2508 Highway 70
Braham, MN 55006-3759
Phone (320) 396-5068
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3C231VA | Other | MN | BLUE CROSS BLUE SHIELD |
Other providers in North Oaks, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.