NPIMap

Organization Active NPI

Integrated Chiropractic Services

  • Chiropractor
  • White Bear Lake, MN
National Provider Identifier
1538468293
Registry record updated Mar 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3592 Issued in MN
Legal business name
INTEGRATED CHIROPRACTIC SERVICES
Practice address
4422 White Bear Ave N
White Bear Lake, MN 55110-3475
Phone
(651) 287-8780
Fax
(651) 287-8786
NPI assigned
Mar 21, 2011
Last updated
Mar 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2011

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

Authorized official

Name
Dr. Brent David Venables, DC
Title
Partner
Phone
(651) 287-8780

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3592 MN Primary

Addresses

Primary practice location

4422 White Bear Ave N
White Bear Lake, MN 55110-3475

Mailing address

4422 White Bear Ave N
White Bear Lake, MN 55110-3475
Phone (651) 287-8780

Other identifiers 1

IdentifierTypeStateIssuer
822520600MedicaidMN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1300665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300665600000",
    "number": "1538468293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4422 WHITE BEAR AVE N",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103475",
            "telephone_number": "651-287-8780",
            "fax_number": "651-287-8786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4422 WHITE BEAR AVE N",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103475",
            "telephone_number": "651-287-8780",
            "fax_number": "651-287-8786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED CHIROPRACTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-21",
        "last_updated": "2011-03-21",
        "status": "A",
        "authorized_official_last_name": "VENABLES",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "651-287-8780",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "822520600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2011; 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.