NPIMap

Organization Active NPI

Kent J. Erickson, D.C., CHTD

Doing business as Brookdale Health

  • Chiropractor
  • Brooklyn Center, MN
National Provider Identifier
1720090814
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
KENT J. ERICKSON, D.C., CHTD
Doing business as
Brookdale Health
Practice address
5740 Brooklyn Blvd
#100
Brooklyn Center, MN 55429
Phone
(763) 561-4045
Fax
(763) 561-8690
NPI assigned
Aug 13, 2006
Last updated
Sep 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Authorized official

Name
Kent J Erickson, DCNPI 1740217694
Title
Clinic Director
Phone
(763) 561-4045

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

5740 Brooklyn Blvd
#100
Brooklyn Center, MN 55429

Mailing address

5740 Brooklyn Blvd
#100
Brooklyn Center, MN 55429
Phone (763) 561-4045

Other identifiers 1

IdentifierTypeStateIssuer
044727700MedicaidMN

Other names 1

  • Brookdale Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040817001356 MN Part B Supplier - Clinic/Group Practice 6507839586 Receives reassigned benefits from 7 practitioners
Practice locations: Brooklyn Center, MN

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2341315Kent J. Erickson DC CHTD Dba Brookdale Health5740 Brooklyn Blvd, Suite 100, Brooklyn Center, MN 55429Certificate of waiverMar 30, 2028

National Provider Directory

National Provider Directory

Locations

5740 Brooklyn Blvd
Ste 100
Minneapolis, MN 55429
Phone (612) 561-4045

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600732800000",
    "number": "1720090814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5740 BROOKLYN BLVD",
            "address_2": "#100",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "55429",
            "telephone_number": "763-561-4045",
            "fax_number": "763-561-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5740 BROOKLYN BLVD",
            "address_2": "#100",
            "city": "BROOKLYN CENTER",
            "state": "MN",
            "postal_code": "55429",
            "telephone_number": "763-561-4045",
            "fax_number": "763-561-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT J. ERICKSON, D.C., CHTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "763-561-4045",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044727700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookdale Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookdale Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn Center, MN

Sources for this page

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

Verify at the official NPI Registry.