Active NPI
Jordan Shilts
- Chiropractor
- Edina, MN
National Provider Identifier
1750912291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 6704
- Practice address
- 4820 W 77TH St Ste 150
Edina, MN 55435-4822 - Phone
- (920) 323-2243
- NPI assigned
- Feb 3, 2020
- Reactivated
- Sep 18, 2020
- Last updated
- Sep 18, 2020
- 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 | 6704 | MN | Primary |
Addresses
Primary practice location
4820 W 77TH St Ste 150
Edina, MN 55435-4822
Mailing address
4820 W 77TH St Ste 150
Edina, MN 55435-4822
Phone (920) 323-2243
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Statera Health PLLC | Chiropractor | Current | Accepting new patients |
Locations
4820 77th St W
Ste 150
Minneapolis, MN 55435
Phone (920) 323-2243
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1600387200000",
"number": "1750912291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4820 W 77TH ST STE 150",
"city": "EDINA",
"state": "MN",
"postal_code": "554354822",
"telephone_number": "920-323-2243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4820 W 77TH ST STE 150",
"city": "EDINA",
"state": "MN",
"postal_code": "554354822",
"telephone_number": "920-323-2243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHILTS",
"first_name": "JORDAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-03",
"last_updated": "2020-09-18",
"certification_date": "2020-09-18",
"deactivation_date": "2020-03-04",
"reactivation_date": "2020-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "6704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.