NPIMap

Organization Active NPI

Southwest Chiropractic. LLC

  • Chiropractor
  • Eden Prairie, MN
National Provider Identifier
1487864906
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2103 Issued in MN
Legal business name
SOUTHWEST CHIROPRACTIC. LLC
Practice address
7565 Office Ridge Cir
Eden Prairie, MN 55344-3651
Phone
(952) 943-1188
Fax
(952) 943-1177
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Bradley Dale WildbergNPI 1528086311
Title
Owner
Phone
(715) 748-2334

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: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2103 MN Primary

Addresses

Primary practice location

7565 Office Ridge Cir
Eden Prairie, MN 55344-3651

Mailing address

7565 Office Ridge Cir
Eden Prairie, MN 55344-3651
Phone (952) 943-1188

Other identifiers 2

IdentifierTypeStateIssuer
4477843OtherMNHEALTH SERVICES MGMT, INC
59878NOOtherMNBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050718000789 MN Part B Supplier - Clinic/Group Practice 9436186863 Receives reassigned benefits from 2 practitioners
Practice locations: Eden Prairie, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1487864906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7565 OFFICE RIDGE CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443651",
            "telephone_number": "952-943-1188",
            "fax_number": "952-943-1177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7565 OFFICE RIDGE CIR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553443651",
            "telephone_number": "952-943-1188",
            "fax_number": "952-943-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST CHIROPRACTIC. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "WILDBERG",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-748-2334"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH SERVICES MGMT, INC",
            "identifier": "4477843",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "59878NO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; 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.