Individual provider Active NPI

Tyler Hanson, D.C.

  • Chiropractor
  • Woodbury, MN
National Provider Identifier
1386034650
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6001 Issued in MN
Practice address
683 Bielenberg Dr
Suite 103
Woodbury, MN 55125-1705
Phone
(651) 731-0505
Fax
(651) 731-0500
NPI assigned
Jan 26, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 6001 MN Primary

Addresses

Primary practice location

683 Bielenberg Dr
Suite 103
Woodbury, MN 55125-1705

Mailing address

683 Bielenberg Dr
Suite 103
Woodbury, MN 55125-1705
Phone (651) 731-0505

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150806011270 MN Practitioner - Chiropractic 9739493578 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern University Feinberg Medical School, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

730 Apollo Dr
Suite 120
Lino Lakes, MN 55014-3037

730 Apollo Dr
Suite 120
Circle Pines, MN 55014-3038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6001MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Chiropractic and Wellness Center LLC CurrentSince Jan 1, 2017 Accepting new patients

Locations

730 Apollo Dr
Ste 120
Lino Lakes, MN 55014
Phone (651) 784-2105

Organizations & group practices 1

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": "1422230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422230400000",
    "number": "1386034650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "683 BIELENBERG DR",
            "address_2": "SUITE 103",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251705",
            "telephone_number": "651-731-0505",
            "fax_number": "651-731-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "683 BIELENBERG DR",
            "address_2": "SUITE 103",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251705",
            "telephone_number": "651-731-0505",
            "fax_number": "651-731-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSON",
        "first_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; 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.