Brenwyn Anne Lisa Peddycoart, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3350 Issued in MN

Practice address

1803 Buerkle Rd
Suite 100
White Bear Lake, MN 55110-5269

Phone

(651) 770-8424

Fax

(651) 770-3170

NPI assigned

Feb 7, 2007

Last updated

Aug 27, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Peddycoart Chiropractic Inc.

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1205144722
  NPD (past) Authorized official

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282867200000",
    "number": "1558401968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 BUERKLE RD",
            "address_2": "SUITE 101",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105269",
            "telephone_number": "651-770-8424",
            "fax_number": "651-770-3170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 BUERKLE RD",
            "address_2": "SUITE 100",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105269",
            "telephone_number": "651-770-8424",
            "fax_number": "651-770-3170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDDYCOART",
        "first_name": "BRENWYN",
        "middle_name": "ANNE LISA",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-07",
        "last_updated": "2010-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3350",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "11F47PE",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emea Pauline Hipolito Parungao
• Melissa Pascoe, LGSW
• Ty Evan Paulick, D.C.
• Peace of Mind Home Care, LLC
• Peddycoart Chiropractic Inc.
• Teresa A Pena, MD
• Kathleen Jo Penn, LPCC
• Anna Lee Percival, OD
• Jessica Walker Perkins
• Danielle R Perry Ramirez, MD

• Chiropractor in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; 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.