Northern Lakes Chiropractic LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

NORTHERN LAKES CHIROPRACTIC LLC

Practice address

2340 Mountain Shadow Dr
Duluth, MN 55811-3809

Phone

(218) 208-4627

NPI assigned

Mar 19, 2020

Last updated

Mar 19, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bryce Benson, DCNPI 1124654306

Title

Owner

Phone

(218) 208-4627

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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.

• Bryce Benson, DC

  • Chiropractor
  • Duluth, MN
  • NPI 1124654306
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1584576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1396371571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 MOUNTAIN SHADOW DR",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558113809",
            "telephone_number": "218-208-4627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 MOUNTAIN SHADOW DR",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558113809",
            "telephone_number": "218-208-4627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LAKES CHIROPRACTIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-19",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "BENSON",
        "authorized_official_first_name": "BRYCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-208-4627",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Duluth, MN
• Providers in Duluth, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; 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.