Organization Active NPI

Wellness 1St of Austin Inc

  • Chiropractor
  • Austin, MN
National Provider Identifier
1528255973
Registry record updated Nov 14, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
WELLNESS 1ST OF AUSTIN INC
Practice address
300 W Oakland Ave
Austin, MN 55912
Phone
(507) 437-7781
Fax
(507) 437-2937
NPI assigned
Oct 1, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2012

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

Authorized official

Name
Dr. Kelly J Nesvold, DCNPI 1861523037
Title
Doctor
Phone
(507) 437-7781

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 Primary

Addresses

Primary practice location

300 W Oakland Ave
Austin, MN 55912

Mailing address

300 W Oakland Ave
Austin, MN 55912
Phone (507) 437-7781

Other identifiers 3

IdentifierTypeStateIssuer
P00236504OtherMNRAILROAD
819637100MedicaidMN
906S3WEOtherMNBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041115001136 MN Part B Supplier - Clinic/Group Practice 3678537107 Receives reassigned benefits from 1 practitioner
Practice locations: Austin, MN

National Provider Directory

National Provider Directory

Locations

204 4th St SW
Austin, MN 55912
Phone (507) 433-6344

300 W Oakland Ave
Austin, MN 55912
Phone (507) 437-7781

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1191196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1352851200000",
    "number": "1528255973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W OAKLAND AVE",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "55912",
            "telephone_number": "507-437-7781",
            "fax_number": "507-437-2937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W OAKLAND AVE",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "55912",
            "telephone_number": "507-437-7781",
            "fax_number": "507-437-2937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS 1ST OF AUSTIN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-01",
        "last_updated": "2012-11-14",
        "status": "A",
        "authorized_official_last_name": "NESVOLD",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "507-437-7781",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00236504",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "819637100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "906S3WE",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2012; 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.