Active NPI
Kayla Middendorf, DC
- Chiropractor
- Andover, MN
National Provider Identifier
1407497548
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 6652
- Practice address
- 1777 Bunker Lake Blvd NW # 200
Andover, MN 55304-4008 - Phone
- (763) 413-6934
- NPI assigned
- Sep 30, 2019
- Last updated
- Sep 30, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 6652 | MN | Primary |
Addresses
Primary practice location
1777 Bunker Lake Blvd NW # 200
Andover, MN 55304-4008
Mailing address
4251 W 125TH St
Savage, MN 55378-1413
Phone (320) 429-0044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6652 | MN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569801600000",
"number": "1407497548",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4251 W 125TH ST",
"city": "SAVAGE",
"state": "MN",
"postal_code": "553781413",
"telephone_number": "320-429-0044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1777 BUNKER LAKE BLVD NW # 200",
"city": "ANDOVER",
"state": "MN",
"postal_code": "553044008",
"telephone_number": "763-413-6934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDDENDORF",
"first_name": "KAYLA",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-09-30",
"last_updated": "2019-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "6652",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Andover, MN
- Stacey E Meath, LICSW
- Kallie Medenwald, M.S CF-SLP
- Medexpress Urgent Care Minnesota P.C. (MedExpress Urgent Care - Andover, Bunker Lake Blvd NW)
- Allison Merriman, LMFT
- Kendra Mertes, MOTR/L
- Rochelle Milbrath, CCC-SLP
- Milk Moms, Inc
- Milk Moms, Inc (Heather's Mastectomy Boutique)
- Samantha Nichole Mogen, LICSW
- Nicole Elaine Mold, OTR/L
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.