NPIMap

Organization Active NPI

Roseville Chiropractic Clinic, LLC

  • Chiropractor
  • Lino Lakes, MN
National Provider Identifier
1699054304
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5493 Issued in MN
Legal business name
ROSEVILLE CHIROPRACTIC CLINIC, LLC
Doing business as
Sprout Chiropractic & Wellness
Practice address
7525 Village Dr Ste 110
Lino Lakes, MN 55014-1305
Phone
(651) 247-0941
NPI assigned
Aug 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Authorized official

Name
Jennifer Kay Massa
Title
Owner
Phone
(612) 424-5757

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 5493 MN Primary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X 4755-012 WI

Addresses

Primary practice location

7525 Village Dr Ste 110
Lino Lakes, MN 55014-1305

Mailing address

7525 Village Dr Ste 110
Lino Lakes, MN 55014-1305
Phone (612) 424-5757

Other names 1

  • Sprout Chiropractic & Wellness Doing business as

National Provider Directory

National Provider Directory

Locations

7525 Village Dr
Ste 110
Lino Lakes, MN 55014
Phone (612) 424-5757

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658102400000",
    "number": "1699054304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7525 VILLAGE DR STE 110",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141305",
            "telephone_number": "612-424-5757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7525 VILLAGE DR STE 110",
            "city": "LINO LAKES",
            "state": "MN",
            "postal_code": "550141305",
            "telephone_number": "651-247-0941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSEVILLE CHIROPRACTIC CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A",
        "authorized_official_last_name": "MASSA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-424-5757"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5493",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "4755-012",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sprout Chiropractic & Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lino Lakes, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.