NPIMap

Organization Active NPI

Simply Chiropractic Center, P.a.

  • Chiropractor
  • White Bear Lake, MN
National Provider Identifier
1407125099
Registry record updated Dec 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5081 Issued in MN
Legal business name
SIMPLY CHIROPRACTIC CENTER, P.A.
Practice address
4886 Highway 61 N
Suite 201
White Bear Lake, MN 55110-2857
Phone
(651) 762-4757
NPI assigned
Dec 28, 2011
Organization subpart
Yes
Parent organization
SIMPLY CHIROPRACTIC CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 28, 2011

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

Authorized official

Name
Dr. Jill Marie FriedrichsNPI 1912185448
Title
Chiropractor
Phone
(651) 762-4757

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
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 5081 MN Primary

Addresses

Primary practice location

4886 Highway 61 N
Suite 201
White Bear Lake, MN 55110-2857

Mailing address

4886 Highway 61 N
Suite 201
White Bear Lake, MN 55110-2857
Phone (651) 762-4757

Other identifiers 1

IdentifierTypeStateIssuer
1912185448OtherMNNPI PERSONAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130214000490 MN Part B Supplier - Clinic/Group Practice 6103070495 Receives reassigned benefits from 1 practitioner
Practice locations: White Bear Lake, MN

National Provider Directory

National Provider Directory
Part of
Simply Chiropractic Center PA

Practitioners & affiliated clinicians

Practitioners 3

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": "1325030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325030400000",
    "number": "1407125099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4886 HIGHWAY 61 N",
            "address_2": "SUITE 201",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102857",
            "telephone_number": "651-762-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4886 HIGHWAY 61 N",
            "address_2": "SUITE 201",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102857",
            "telephone_number": "651-762-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMPLY CHIROPRACTIC CENTER, P.A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SIMPLY CHIROPRACTIC CENTER",
        "enumeration_date": "2011-12-28",
        "last_updated": "2011-12-28",
        "status": "A",
        "authorized_official_last_name": "FRIEDRICHS",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "651-762-4757",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI PERSONAL",
            "identifier": "1912185448",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; 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.