Active NPI
Peter Albert Landry, D.C.
- Chiropractor
- Elk River, MN
National Provider Identifier
1669430062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3805
- Practice address
- 19449 Evans St NW
Suite a
Elk River, MN 55330-1074 - Phone
- (612) 702-9012
- Fax
- (763) 633-0039
- NPI assigned
- May 3, 2006
- Last updated
- Jul 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 3805 | MN | Primary |
Addresses
Primary practice location
19449 Evans St NW
Suite a
Elk River, MN 55330-1074
Mailing address
19449 Evans St NW
Suite a
Elk River, MN 55330-1074
Phone (612) 702-9012
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 94631 | Other | MN | HEALTH PARTNERS GROUP NUM |
| 4487073 | Other | MN | MEDICA GROUP ID |
| 45D48LA | Other | MN | BLUECROSS PIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3805 | MN | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Landry Chiropractic Inc. | Chiropractor | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Chiropractor
- Elk River, MN
- NPI 1467642843
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185753600000",
"number": "1669430062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19449 EVANS ST NW",
"address_2": "SUITE A",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301074",
"telephone_number": "612-702-9012",
"fax_number": "763-633-0039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19449 EVANS ST NW",
"address_2": "SUITE A",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301074",
"telephone_number": "612-702-9012",
"fax_number": "763-633-0039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDRY",
"first_name": "PETER",
"middle_name": "ALBERT",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-03",
"last_updated": "2007-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "3805",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH PARTNERS GROUP NUM",
"identifier": "94631",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA GROUP ID",
"identifier": "4487073",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS PIN",
"identifier": "45D48LA",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.