NPIMap

Organization Active NPI

Knewtson Family Chiropractic PA

  • Chiropractor
  • Excelsior, MN
National Provider Identifier
1477589109
Registry record updated Dec 3, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
KNEWTSON FAMILY CHIROPRACTIC PA
Practice address
23505 Smithtown Rd
Ste 100
Excelsior, MN 55331-4541
Phone
(952) 470-8555
Fax
(952) 401-8785
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2007

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

Authorized official

Name
Dr. Kelly Melissa Knewtson, DCNPI 1790799260
Title
Doctor / President
Phone
(952) 470-8555

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: 193200000X MULTI-SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

23505 Smithtown Rd
Ste 100
Excelsior, MN 55331-4541

Mailing address

23505 Smithtown Rd
Ste 100
Excelsior, MN 55331-4541
Phone (952) 470-8555

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050119000816 MN Part B Supplier - Clinic/Group Practice 3779532593 Receives reassigned benefits from 10 practitioners
Practice locations: Excelsior, MN

National Provider Directory

National Provider Directory

Locations

386 Oak St
Excelsior, MN 55331
Phone (952) 250-6820

23505 Smithtown Rd
Shorewood, MN 55331
Phone (952) 470-8555

Practitioners & affiliated clinicians

Practitioners 37

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

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196640000000",
    "number": "1477589109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23505 SMITHTOWN RD",
            "address_2": "STE 100",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553314541",
            "telephone_number": "952-470-8555",
            "fax_number": "952-401-8785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23505 SMITHTOWN RD",
            "address_2": "STE 100",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553314541",
            "telephone_number": "952-470-8555",
            "fax_number": "952-401-8785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNEWTSON FAMILY CHIROPRACTIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2007-12-03",
        "status": "A",
        "authorized_official_last_name": "KNEWTSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MELISSA",
        "authorized_official_title_or_position": "DOCTOR / PRESIDENT",
        "authorized_official_telephone_number": "952-470-8555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Excelsior, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; 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.