Organization Active NPI

Kenwood Chiropractic Arts PA

  • Chiropractor
  • Minneapolis, MN
National Provider Identifier
1730284753
Registry record updated Mar 11, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1257 Issued in MN
Legal business name
KENWOOD CHIROPRACTIC ARTS PA
Practice address
1311 W 25TH St
Minneapolis, MN 55405-2620
Phone
(612) 374-3392
Fax
(612) 374-3477
NPI assigned
Sep 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2013

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

Authorized official

Name
Dr. David Stussy, D.C.
Title
Owner
Phone
(612) 374-3392

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 1257 MN Primary

Addresses

Primary practice location

1311 W 25TH St
Minneapolis, MN 55405-2620

Mailing address

1311 W 25TH St
Minneapolis, MN 55405-2620
Phone (612) 374-3392

Other identifiers 1

IdentifierTypeStateIssuer
738325800MedicaidMN

National Provider Directory

National Provider Directory

Locations

1311 W 25th St
Minneapolis, MN 55405
Phone (612) 374-3392

3313 Republic Ave
St Louis Park, MN 55426
Phone (612) 374-3392

3340 Republic Ave
Ste 150
St Louis Park, MN 55426
Phone (612) 374-3392

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362960000000",
    "number": "1730284753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 W 25TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052620",
            "telephone_number": "612-374-3392",
            "fax_number": "612-374-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1311 W 25TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052620",
            "telephone_number": "612-374-3392",
            "fax_number": "612-374-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENWOOD CHIROPRACTIC ARTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2013-03-11",
        "status": "A",
        "authorized_official_last_name": "STUSSY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-374-3392",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "1257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "738325800",
            "state": "MN"
        }
    ],
    "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 Mar 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.