Prior Lake Spine Health & Injury Center, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5230 Issued in MN

Legal business name

PRIOR LAKE SPINE HEALTH & INJURY CENTER, PLLC

Practice address

16197 Main Ave SE
Prior Lake, MN 55372-1704

Phone

(952) 226-5100

Fax

(952) 516-5240

NPI assigned

Nov 8, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Joshua R RickertNPI 1932333176

Title

Owner/Ceo

Phone

(952) 226-5100

Specialties & licenses 1

Addresses

Other names 1

• Prior Lake Spine 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.

• Joshua R Rickert, D.C.

  • Chiropractor
  • Prior Lake, MN
  • NPI 1932333176
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1320710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343347200000",
    "number": "1700163573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16197 MAIN AVE SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721704",
            "telephone_number": "952-226-5100",
            "fax_number": "952-516-5240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16197 MAIN AVE SE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721704",
            "telephone_number": "952-226-5100",
            "fax_number": "952-516-5240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIOR LAKE SPINE HEALTH & INJURY CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-08",
        "last_updated": "2012-07-27",
        "status": "A",
        "authorized_official_last_name": "RICKERT",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "952-226-5100",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5230",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prior Lake Spine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pivotal Family Chiropractic LLC
• Katherine Price, OTR/L
• Prior Lake
• Prior Lake Natural Health Clinic
• Prior Lake Ops LLC
• Prior Lake-Savage Independent School District #719
• Charles Walter Puffer, DDS
• Redwood Counseling LLC
• Theresa Rae Reese, APRN, PNP-PC
• Lauren Emily Resh, PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; 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.