Organization Active NPI

Advanced Chiropractic & Wellness, P.a.

  • Chiropractor
  • Roseville, MN
National Provider Identifier
1700941069
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4749 Issued in MN
Legal business name
ADVANCED CHIROPRACTIC & WELLNESS, P.A.
Practice address
1752 Lexington Ave N
Roseville, MN 55113-6516
Phone
(651) 779-5998
Fax
(651) 779-7165
NPI assigned
Dec 27, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Eric Brian Lund, D.C.NPI 1316901853
Title
Owner Doctor of Chiropractic
Phone
(651) 779-5998

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 1

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20051228000222 MN Part B Supplier - Clinic/Group Practice 1456373976 Receives reassigned benefits from 1 practitioner
Practice locations: Roseville, MN

National Provider Directory

Locations

1701 Cope Ave E
Ste A
Maplewood, MN 55109
Phone (651) 216-1993

1704 Lexington Ave N
Saint Paul, MN 55113
Phone (651) 779-5998

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 4749 MN Primary

Addresses

NPPES NPI Registry

Primary practice location

1752 Lexington Ave N
Roseville, MN 55113-6516

Mailing address

1752 Lexington Ave N
Roseville, MN 55113-6516
Phone (651) 779-5998

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
594K7ADOtherMNBLUECROSS BLUESHIELD

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700941069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1752 LEXINGTON AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551136516",
            "telephone_number": "651-779-5998",
            "fax_number": "651-779-7165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1752 LEXINGTON AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551136516",
            "telephone_number": "651-779-5998",
            "fax_number": "651-779-7165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED CHIROPRACTIC & WELLNESS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUND",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "651-779-5998",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "4749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "594K7AD",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

  • 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.