NPIMap

Organization Active NPI

Blaine Chiropractic Center PA

  • Chiropractor
  • Blaine, MN
National Provider Identifier
1376759589
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
82 Issued in MN
Legal business name
BLAINE CHIROPRACTIC CENTER PA
Practice address
11919 Central Ave NE
Blaine, MN 55434-3911
Phone
(763) 757-1660
Fax
(763) 757-4108
NPI assigned
May 15, 2007
Last updated
Apr 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Authorized official

Name
Samuel Steven SchwietersNPI 1790370872
Title
President
Phone
(763) 757-1660

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 82 MN Primary

Addresses

Primary practice location

11919 Central Ave NE
Blaine, MN 55434-3911

Mailing address

11919 Central Ave NE
Blaine, MN 55434-3911
Phone (763) 757-1660

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101117001410 MN Part B Supplier - Clinic/Group Practice 0547456444 Receives reassigned benefits from 5 practitioners
Practice locations: Blaine, MN

National Provider Directory

National Provider Directory

Locations

11919 Central Ave NE
Minneapolis, MN 55434
Phone (763) 757-1600

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712016000000",
    "number": "1376759589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11919 CENTRAL AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343911",
            "telephone_number": "763-757-1660",
            "fax_number": "763-757-4108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11919 CENTRAL AVE NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343911",
            "telephone_number": "763-757-1660",
            "fax_number": "763-757-4108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAINE CHIROPRACTIC CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-15",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A",
        "authorized_official_last_name": "SCHWIETERS",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-757-1660"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "82",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blaine, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.