Active NPI
Kevin Anthony Berg, D.C.
- Chiropractor
- Minneapolis, MN
National Provider Identifier
1710197710
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 3642
- Practice address
- 8200 Humboldt Ave S Ste 204
Minneapolis, MN 55431-1432 - Phone
- (952) 884-6144
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 3642 | MN | Primary |
Addresses
Primary practice location
8200 Humboldt Ave S Ste 204
Minneapolis, MN 55431-1432
Mailing address
6120 Washburn Ave S
Minneapolis, MN 55410-2851
Phone (612) 386-8636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3642 | MN | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mystical Rose Chiropractic LLC | Past | Accepting new patients | |
| Institute for Chiropractic Rehabilitation PA | Chiropractor | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Chiropractor
- Bloomington, MN
- NPI 1922242627
-
- Health Maintenance Organization
- Bloomington, MN
- NPI 1649555715
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710197710",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6120 WASHBURN AVE S",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554102851",
"telephone_number": "612-386-8636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 HUMBOLDT AVE S STE 204",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554311432",
"telephone_number": "952-884-6144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "KEVIN",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "D.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "3642",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.