Jeff Brist, D.C.
Individual provider Active NPI Chiropractor · Champlin, MN
NPI 1497974950 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497974950
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 2487 (MN)
- Practice address
- 12176 Ensign Ave N
Champlin, MN 55316-1944 - Phone
- (763) 546-9151
- Fax
- (763) 546-8885
- NPI assigned
- Apr 24, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2487 | MN | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 2487 | MN | Yes |
Addresses
Primary practice location
12176 Ensign Ave N
Champlin, MN 55316-1944
Mailing address
12176 Ensign Ave N
Champlin, MN 55316-1944
Phone (763) 546-9151
Other providers in Champlin, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.