Bass Lake Chiropractic Clinic, P.a.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC4020 Issued in MN

Legal business name

BASS LAKE CHIROPRACTIC CLINIC, P.A.

Practice address

5640 W Broadway Ave
Crystal, MN 55428-3556

Phone

(763) 537-8070

Fax

(763) 537-9513

NPI assigned

Oct 2, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Heather Marie Vinje, D.C.NPI 1861597759

Title

Owner

Phone

(763) 537-8070

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 6

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.

• Jonathan Wesley Morris, D.C.

  • Chiropractor
  • Crystal, MN
  • NPI 1609140318
  Medicare reassignment NPD
• Kristin L Johnson, D.C.

  • Chiropractor
  • New Hope, MN
  • NPI 1104143007
  Medicare reassignment
• Heather Marie Vinje, D.C.

  • Chiropractor
  • Crystal, MN
  • NPI 1861597759
  Authorized official Same address or phone
• Jenna M Boren, D.C.

  • Chiropractor
  • Saint Paul, MN
  • NPI 1073560496
  NPD (past)
• Amanda Rachel Gebhardt-Fitzgerald, DC

  • Chiropractor
  • Woodbury, MN
  • NPI 1518069756
  NPD (past)
• Michelle Marie Greenman, D.C.

  • Chiropractor
  • Crystal, MN
  • NPI 1013012913
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1487747226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5640 W BROADWAY AVE",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554283556",
            "telephone_number": "763-537-8070",
            "fax_number": "763-537-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5640 W BROADWAY AVE",
            "city": "CRYSTAL",
            "state": "MN",
            "postal_code": "554283556",
            "telephone_number": "763-537-8070",
            "fax_number": "763-537-9513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASS LAKE CHIROPRACTIC CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "VINJE",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-537-8070",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "DC4020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP ID #",
            "identifier": "4C416HU",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Azure Ride
• Risa Bache-Wiig, MD
• Back to Life Natural Health Center
• Ofer Barniv, PAC
• Kristine Barrett
• Allyson Bauer, MPS, LADC, LPCC
• Colleen Noel Bayer, MA
• Benjamin Carl Behnen
• Christopher A Bennett, M.D.
• Melodee Jean Benson, LADC

• Chiropractor in Crystal, MN
• Providers in Crystal, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.