NPIMap

Organization Active NPI

Advanced Brain and Body Clinic PLLC

  • Specialist
  • Golden Valley, MN
National Provider Identifier
1447816632
Registry record updated Jul 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ADVANCED BRAIN AND BODY CLINIC PLLC
Practice address
701 Decatur Ave N Ste 109
Golden Valley, MN 55427-4363
Phone
(605) 348-8000
Fax
(605) 716-0248
NPI assigned
May 14, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2025

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

Authorized official

Name
Stephen Paul Manlove, MDNPI 1619021672
Title
Owner
Phone
(605) 348-8000

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
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

701 Decatur Ave N Ste 109
Golden Valley, MN 55427-4363

Mailing address

636 Saint Anne St
Rapid City, SD 57701-4694
Phone (605) 348-8000

Other practice location 1

13911 Ridgedale Dr Ste 110
Minnetonka, MN 55305-1773
Phone (605) 348-8000 ext. 211

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190815002427 MN Part B Supplier - Clinic/Group Practice 7911234711 Receives reassigned benefits from 12 practitioners
Practice locations: Minnetonka, MN

National Provider Directory

National Provider Directory

Locations

126 3rd St N
Ste 402
Minneapolis, MN 55401
Phone 6053488000219

13911 Ridgedale Dr
Ste 110
Minnetonka, MN 55305
Phone 6053488000 ext. 211

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752105600000",
    "number": "1447816632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 SAINT ANNE ST",
            "city": "RAPID CITY",
            "state": "SD",
            "postal_code": "577014694",
            "telephone_number": "605-348-8000",
            "fax_number": "605-716-0248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DECATUR AVE N STE 109",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274363",
            "telephone_number": "605-348-8000",
            "fax_number": "605-716-0248"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13911 Ridgedale Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Minnetonka",
            "state": "MN",
            "postal_code": "553051773",
            "country_code": "US",
            "telephone_number": "605-348-8000 x211",
            "fax_number": "605-716-0248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED BRAIN AND BODY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-14",
        "last_updated": "2025-07-10",
        "certification_date": "2025-07-10",
        "status": "A",
        "authorized_official_last_name": "MANLOVE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "605-348-8000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Golden Valley, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2025; 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.