Restore Chiropractic and Wellness

Key facts

NPI

1487453239

Entity type

Organization (NPI type 2)

Primary specialty

Chiropractor 111N00000X

Legal business name

RESTORE CHIROPRACTIC AND WELLNESS

Practice address

711 3Rd St
Jackson, MN 56143-1614

Phone

(402) 518-1444

NPI assigned

Mar 12, 2025

Organization subpart

No

Authorized official

Name

Miranda Lorelei Fisk, D.C. NPI 1306683453

Title

Owner/Chiropractor

Phone

(402) 518-1444

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 2

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

• Miranda Lorelei Fisk, DC Chiropractor · Jackson, MN · NPI 1306683453
  Medicare reassignment Authorized official MN
• Clayton Roy Lewis, D.C. Sports Physician Chiropractor · Jackson, MN · NPI 1639265952
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MN

Medicare enrollment records

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 29, 2025.

{
    "created_epoch": "1741737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1487453239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 3RD ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431614",
            "telephone_number": "402-518-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 3RD ST",
            "city": "JACKSON",
            "state": "MN",
            "postal_code": "561431614",
            "telephone_number": "402-518-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE CHIROPRACTIC AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-12",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "FISK",
        "authorized_official_first_name": "MIRANDA",
        "authorized_official_middle_name": "LORELEI",
        "authorized_official_title_or_position": "OWNER/CHIROPRACTOR",
        "authorized_official_telephone_number": "402-518-1444",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MN

• Paul a Roggow DDS PC
• Prairie Rehabilitation Services, Inc
• Prairie Rehabilitation Services, Inc.
• Premise Health of Minnesota Medical PC
• Travis Dennis Rath, DO
• Polina B Rivera, CNP
• Linda E. Roggow, MSW, LICSW
• Paul Anthony Roggow, D.D.S.
• Tracy Marie Ross, ARNP
• Sacred Heart Mercy Health Care Center

All providers in Jackson, MN · Chiropractor in Minnesota