Southwest Chiropractic Clinic of Worthington, PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4388 Issued in MN

Legal business name

SOUTHWEST CHIROPRACTIC CLINIC OF WORTHINGTON, PA

Practice address

1301 Diagonal Rd
Worthington, MN 56187-1114

Phone

(507) 376-9663

Fax

(507) 376-9663

NPI assigned

Jan 8, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jacob John Roethler, D.C.NPI 1386742906

Title

President, Chiropractor

Phone

(507) 376-9663

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jacob John Roethler, D.C.

  • Chiropractor
  • Worthington, MN
  • NPI 1386742906
  Medicare reassignment NPD Authorized official
• Mark E. Quandt, D.C.

  • Chiropractor
  • Roseville, MN
  • NPI 1558428250
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700934429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 DIAGONAL RD",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871114",
            "telephone_number": "507-376-9663",
            "fax_number": "507-376-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 DIAGONAL RD",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871114",
            "telephone_number": "507-376-9663",
            "fax_number": "507-376-9663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST CHIROPRACTIC CLINIC OF WORTHINGTON, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROETHLER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT, CHIROPRACTOR",
        "authorized_official_telephone_number": "507-376-9663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4388",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "072H0SO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacy Wahl Slettum, FNP
• Katherine Elizabeth Smidt, CNM
• Grant R Sorensen, D.D.S.
• Maureen A Sorensen, D.D.S.
• Southshore Operations, LLC (South Shore Care Center)
• Southwest Hearing Aid Center Inc
• Southwest Hearing Technologies, Inc.
• Southwestern Minnesota Adult Mental Health Consortium (Southwinds Assertive Community Treatment)
• Southwestern Minnesota Opportunity Council, Inc CTC
• Southwestern Minnesota Opportunity Council, Inc.

• Chiropractor in Worthington, MN
• Providers in Worthington, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.