NPIMap

Organization Active NPI

Boulevard Chiropractic Clinic, P.a.

  • Orthopedic Chiropractor
  • St Louis Park, MN
National Provider Identifier
1568544864
Registry record updated Dec 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic ChiropractorTaxonomy code 111NX0800X
License
1266 Issued in MN
Legal business name
BOULEVARD CHIROPRACTIC CLINIC, P.A.
Practice address
7200 Minnetonka Blvd
St Louis Park, MN 55426-3210
Phone
(952) 925-4847
Fax
(952) 925-4211
NPI assigned
Oct 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2013

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

Authorized official

Name
Dr. Chad Alan Paulson, D.C.
Title
Manager
Phone
(952) 925-4847

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111NX0800X 1266 MN Primary

Addresses

Primary practice location

7200 Minnetonka Blvd
St Louis Park, MN 55426-3210

Mailing address

7200 Minnetonka Blvd
St Louis Park, MN 55426-3210
Phone (952) 925-4847

Other identifiers 1

IdentifierTypeStateIssuer
479324200MedicaidMN

National Provider Directory

National Provider Directory

Locations

7200 Minnetonka Blvd
St Louis Park, MN 55426
Phone (952) 925-4847

Practitioners & affiliated clinicians

Practitioners 4

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": "1161216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386547200000",
    "number": "1568544864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 MINNETONKA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263210",
            "telephone_number": "952-925-4847",
            "fax_number": "952-925-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7200 MINNETONKA BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263210",
            "telephone_number": "952-925-4847",
            "fax_number": "952-925-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD CHIROPRACTIC CLINIC, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-19",
        "last_updated": "2013-12-09",
        "status": "A",
        "authorized_official_last_name": "PAULSON",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "952-925-4847",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111NX0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Orthopedic",
            "state": "MN",
            "license": "1266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "479324200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; 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.