NPIMap

Organization Active NPI

Family Chiropractic of Warren Inc

  • Chiropractor
  • Warren, MN
National Provider Identifier
1598875171
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3351 Issued in MN
Legal business name
FAMILY CHIROPRACTIC OF WARREN INC
Practice address
603 N Main Street
Warren, MN 56762
Phone
(218) 745-6655
Fax
(218) 745-4049
NPI assigned
Aug 30, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Mark Alan Pederson, DCNPI 1215045604
Title
Doctor
Phone
(218) 745-6655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3351 MN Primary

Addresses

Primary practice location

603 N Main Street
Warren, MN 56762

Mailing address

603 N Main Street
Warren, MN 56762
Phone (218) 745-6655

Other identifiers 2

IdentifierTypeStateIssuer
15F41PEOtherMNBCBS
20215OtherNDBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070524000104 MN Part B Supplier - Clinic/Group Practice 1557468600 Practice locations: Warren, MN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598875171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 N MAIN STREET",
            "city": "WARREN",
            "state": "MN",
            "postal_code": "56762",
            "telephone_number": "218-745-6655",
            "fax_number": "218-745-4049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "603 N MAIN STREET",
            "city": "WARREN",
            "state": "MN",
            "postal_code": "56762",
            "telephone_number": "218-745-6655",
            "fax_number": "218-745-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY CHIROPRACTIC OF WARREN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PEDERSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "218-745-6655",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "15F41PE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "20215",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.