Northstar Chiropractic & Wellness, P. a.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3099 Issued in MN

Legal business name

NORTHSTAR CHIROPRACTIC & WELLNESS, P. A.

Practice address

670 Humboldt Dr
Big Lake, MN 55309-9407

Phone

(763) 263-8433

Fax

(763) 263-2963

NPI assigned

Oct 13, 2010

Organization subpart

No

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

Authorized official

Name

Nathan Erik Davidson, D. C.NPI 1760548085

Title

Owner

Phone

(763) 263-8433

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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

• Nathan E. Davidson, DC

  • Chiropractor
  • Big Lake, MN
  • NPI 1760548085
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1286928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286928000000",
    "number": "1629388533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 HUMBOLDT DR",
            "address_2": "PO BOX 88",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099407",
            "telephone_number": "763-263-8433",
            "fax_number": "763-263-2963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 HUMBOLDT DR",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553099407",
            "telephone_number": "763-263-8433",
            "fax_number": "763-263-2963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSTAR CHIROPRACTIC & WELLNESS, P. A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-13",
        "last_updated": "2010-10-13",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "ERIK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "763-263-8433",
        "authorized_official_credential": "D. C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3099",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300463500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Marie Myhra, MA, LADC
• Deborah M Myhre
• Diane Lisa Neal, M.S. , LPCC
• Sylvia Kooyman Nelson, MT
• Sean Nielsen
• Nystrom Residential Treatment, LLC
• Dylan Michael O'Borsky, DDS
• John Olafson, NP
• David Pachuta, D.D.S.
• Sherry Lynn Parker, LADC

• Chiropractor in Big Lake, MN
• Providers in Big Lake, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; 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.