NPIMap

Organization Active NPI

St. Paul Neck & Back Clinic, PC

Doing business as Brooklyn Center Neck & Back Clinic

  • Chiropractor
  • Brooklyn Center, MN
National Provider Identifier
1457556730
Registry record updated Sep 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3945 Issued in MN
Legal business name
ST. PAUL NECK & BACK CLINIC, PC
Doing business as
Brooklyn Center Neck & Back Clinic
Practice address
2781 Freeway Blvd
Suite 160
Brooklyn Center, MN 55430-1753
Phone
(763) 560-9139
Fax
(763) 560-9149
NPI assigned
Jun 18, 2007
Last updated
Sep 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2012

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

Authorized official

Name
Dr. Jason John Stadther, D.C.NPI 1548218019
Title
Ceo
Phone
(763) 560-9139

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3945 MN Primary

Addresses

Primary practice location

2781 Freeway Blvd
Suite 160
Brooklyn Center, MN 55430-1753

Mailing address

2781 Freeway Blvd
Suite 160
Brooklyn Center, MN 55430-1753
Phone (763) 560-9139

Other names 1

  • Brooklyn Center Neck & Back Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

858 Terrace Ct
Saint Paul, MN 55130
Phone (651) 771-7597

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347926400000",
    "number": "1457556730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2781 FREEWAY BLVD",
            "address_2": "SUITE 160",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554301753",
            "telephone_number": "763-560-9139",
            "fax_number": "763-560-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2781 FREEWAY BLVD",
            "address_2": "SUITE 160",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554301753",
            "telephone_number": "763-560-9139",
            "fax_number": "763-560-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. PAUL NECK & BACK CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2012-09-18",
        "status": "A",
        "authorized_official_last_name": "STADTHER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-560-9139",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brooklyn Center Neck & Back Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn Center, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; 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.