Pequot Lakes Chiropractic PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

PEQUOT LAKES CHIROPRACTIC PA

Practice address

31095 Berquist Dr
Pequot Lakes, MN 56472-5647

Phone

(218) 568-7767

Fax

(218) 568-4580

NPI assigned

Feb 18, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Joshua Alan Dietze, DCNPI 1467874941

Title

Owner

Phone

(218) 568-7677

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joshua Alan Dietze, DC

  • Chiropractor
  • Pequot Lakes, MN
  • NPI 1467874941
  NPD Authorized official

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1417540774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 281",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564720241",
            "telephone_number": "218-568-7767",
            "fax_number": "218-568-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31095 BERQUIST DR",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564725647",
            "telephone_number": "218-568-7767",
            "fax_number": "218-568-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEQUOT LAKES CHIROPRACTIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "DIETZE",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-568-7677",
        "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": []
}

• Brett P Nienaber, MD
• Northmind Wellness PLLP
• Marc Michael Olson
• Angela Pasbrig
• Pequot Lakes Chiropractic and Sports Injury Center P.a
• Pequot Lakes Physical Therapy Services, Inc
• Erin Person-Witt
• Scott Kermit Peterson, RN
• Cynthia L. Rieck, PT
• Deborah A Rudningen, LPC, LADC

• Chiropractor in Pequot Lakes, MN
• Providers in Pequot Lakes, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.