Shingle Creek Medical Group, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

SHINGLE CREEK MEDICAL GROUP, LLC

Practice address

2781 Freeway Blvd
Suite 160
Brooklyn Center, MN 55430-1753

Phone

(763) 244-8020

NPI assigned

Jan 14, 2017

Organization subpart

No

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

Authorized official

Name

Jason John Stadther, DC

Title

Owner

Phone

(763) 244-8021

Specialties & licenses 1

Addresses

Other names 1

• Disc Centers of America Brooklyn Center Doing business as

Locations

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

{
    "created_epoch": "1484352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536624000000",
    "number": "1619413655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2781 FREEWAY BLVD STE 160",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554301765",
            "telephone_number": "763-244-8022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2781 FREEWAY BLVD",
            "address_2": "SUITE 160",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "554301753",
            "telephone_number": "763-244-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINGLE CREEK MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-14",
        "last_updated": "2018-09-11",
        "status": "A",
        "authorized_official_last_name": "STADTHER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-244-8021",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Disc Centers of America Brooklyn Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Chiropractor in Brooklyn Center, MN
• Providers in Brooklyn Center, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; 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.