Pennebaker Clinic of Chiropractic,LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

1392 Issued in MN

Legal business name

PENNEBAKER CLINIC OF CHIROPRACTIC,LLC

Doing business as

Platinum Chiropractoc

Practice address

12300 Singletree LN Ste 200
Eden Prairie, MN 55344-7964

Phone

(952) 941-2225

Fax

(952) 903-2816

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ian A McNeil, D.C.NPI 1467641936

Title

President

Phone

(952) 941-2225

Specialties & licenses 1

Addresses

Other names 1

• Platinum Chiropractoc Doing business as

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.

• Ian A McNeil, D.C.

  • Chiropractor
  • Eden Prairie, MN
  • NPI 1467641936
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1669527636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8140 FLYING CLOUD DR",
            "address_2": "SUITE 201",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445364",
            "telephone_number": "952-941-2225",
            "fax_number": "952-903-2816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12300 SINGLETREE LN STE 200",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553447964",
            "telephone_number": "952-941-2225",
            "fax_number": "952-903-2816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNEBAKER CLINIC OF CHIROPRACTIC,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "MCNEIL",
        "authorized_official_first_name": "IAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-941-2225",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "1392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platinum Chiropractoc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marilou Pederson, C.P.N.P.
• Pediatric Lab Services Inc
• Linda Ruth Peitzman, M.D.
• Marisa Lynn Pender, DNP, FNP-C
• Joanne Penn, M.T.
• Bryan Peralta Garces, DPT, PT
• Andrew Michael Perez
• Joselyn Burgos Perez
• Perham Physical Therapy LTD.
• Periowest, LLC

• Chiropractor in Eden Prairie, MN
• Providers in Eden Prairie, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; 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.