612 Chiropractic & Wellness

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

6232 Issued in MN

Legal business name

612 CHIROPRACTIC & WELLNESS

Practice address

750 Main St
Suite 100
Mendota Heights, MN 55118-3764

Phone

(612) 578-6001

NPI assigned

Sep 8, 2016

Organization subpart

No

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

Authorized official

Name

Kelley Lumbard, DC

Title

Owner

Phone

(612) 578-6001

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1473292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473292800000",
    "number": "1518414382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2211 MONROE ST NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554183635",
            "telephone_number": "612-578-6001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 MAIN ST",
            "address_2": "SUITE 100",
            "city": "MENDOTA HEIGHTS",
            "state": "MN",
            "postal_code": "551183764",
            "telephone_number": "612-578-6001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "612 CHIROPRACTIC & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-08",
        "last_updated": "2016-09-08",
        "status": "A",
        "authorized_official_last_name": "LUMBARD",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-578-6001",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Mendota Heights, MN
• Providers in Mendota Heights, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.