Active NPI
Steven Michael Petry, DC
- Chiropractor
- New Brighton, MN
National Provider Identifier
1710065198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- MN2172
- Practice address
- 2467 15TH St NW
New Brighton, MN 55112 - Phone
- (651) 633-6212
- Fax
- (651) 633-6213
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | MN2172 | MN | Primary |
Addresses
Primary practice location
2467 15TH St NW
New Brighton, MN 55112
Mailing address
2467 15TH St NW
New Brighton, MN 55112
Phone (651) 633-6212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20131118000850 | MN | Practitioner - Chiropractic | 7315173507 | Practice locations: Saint Paul, MN |
Care Compare profile
Medicare Care Compare- Specialty
- Chiropractic
- Education
- Other, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
962 University Ave W
Saint Paul, MN 55104-4703
Phone (651) 644-5304
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MN2172 | MN | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710065198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2467 15TH ST NW",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "55112",
"telephone_number": "651-633-6212",
"fax_number": "651-633-6213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2467 15TH ST NW",
"city": "NEW BRIGHTON",
"state": "MN",
"postal_code": "55112",
"telephone_number": "651-633-6212",
"fax_number": "651-633-6213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRY",
"first_name": "STEVEN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "MN2172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Brighton, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.