Northwest Spine and Pain Center of St. Michael, PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4894 Issued in MN

Legal business name

NORTHWEST SPINE AND PAIN CENTER OF ST. MICHAEL, PA

Practice address

1 Central Ave W
Suite 201
Saint Michael, MN 55376-4591

Phone

(763) 497-0899

Fax

(763) 497-4035

NPI assigned

Mar 28, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Chad Jeffrey Mattila, D.C.NPI 1306903299

Title

Ceo

Phone

(763) 497-0899

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

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

• Chad Jeffrey Mattila, D.C.

  • Chiropractor
  • Otsego, MN
  • NPI 1306903299
  Medicare reassignment NPD Authorized official
• Dustin Philip Mattila, D.C.

  • Chiropractor
  • Howell, MI
  • NPI 1578891693
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233532800000",
    "number": "1609995877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CENTRAL AVE W",
            "address_2": "SUITE 201",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553764591",
            "telephone_number": "763-497-0899",
            "fax_number": "763-497-4035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CENTRAL AVE W",
            "address_2": "SUITE 201",
            "city": "SAINT MICHAEL",
            "state": "MN",
            "postal_code": "553764591",
            "telephone_number": "763-497-0899",
            "fax_number": "763-497-4035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST SPINE AND PAIN CENTER OF ST. MICHAEL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2009-02-02",
        "status": "A",
        "authorized_official_last_name": "MATTILA",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-497-0899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1306903299",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elena Thuy Nguyen
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• Hannah Elizabeth Noyes
• Abraham Nyei
• Ashley O'Konek
• Shem Oino
• Karissa Marie Otten

• Chiropractor in Saint Michael, MN
• Providers in Saint Michael, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2009; 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.