Individual provider Active NPI

Travis Gilbertson, DC

  • Chiropractor
  • Eden Prairie, MN
National Provider Identifier
1720595481
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
6459 Issued in MN
Practice address
755 Prairie Center Dr
Eden Prairie, MN 55344-5363
Phone
(952) 829-8400
NPI assigned
Jan 3, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 6459 MN Primary

Addresses

Primary practice location

755 Prairie Center Dr
Eden Prairie, MN 55344-5363

Mailing address

7661 Heritage Rd
Eden Prairie, MN 55346-4427
Phone (612) 708-2423

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180824002491 MN Practitioner - Chiropractic 5395094213 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Life Clinic, P.a.Group PAC ID 5799934857, 19 clinicians

Practice addresses (Care Compare)

6233 Baker Rd
Eden Prairie, MN 55346-1922
Phone (952) 943-4659

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Life Clinic, P.a. Single Specialty CurrentSince Mar 31, 2025 Accepting new patients
Lifeclinic PA PastSince Mar 31, 2025 Accepting new patients
Jo & Clark Chiropractic, P.a. Chiropractor PastSince Aug 12, 2018 Accepting new patients

Locations

6233 Baker Rd
Eden Prairie, MN 55346
Phone (952) 943-4659

33 Hamline Ave S
Saint Paul, MN 55105
Phone (612) 868-6894

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1514937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1720595481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7661 HERITAGE RD",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553464427",
            "telephone_number": "612-708-2423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 PRAIRIE CENTER DR",
            "city": "EDEN PRAIRIE",
            "state": "MN",
            "postal_code": "553445363",
            "telephone_number": "952-829-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILBERTSON",
        "first_name": "TRAVIS",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-03",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "6459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eden Prairie, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; 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.