Green Lake Chiropractic, PA

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

4176 Issued in MN

Legal business name

GREEN LAKE CHIROPRACTIC, PA

Doing business as

Meridian Disc Institute

Practice address

205 5TH St SW
Willmar, MN 56201-3211

Phone

(320) 214-0044

Fax

(320) 214-0045

NPI assigned

Feb 5, 2008

Last updated

Jun 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jon D. Haefner, D.C.NPI 1386861029

Title

President

Phone

(320) 214-0044

Specialties & licenses 1

Addresses

Other names 1

• Meridian Disc Institute Doing business as

Locations

Practitioners 1

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.

• Jon Haefner, D.C.

  • Chiropractor
  • Willmar, MN
  • NPI 1386861029
  Authorized official Same address or phone

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

{
    "created_epoch": "1202169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212364800000",
    "number": "1760660427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 5TH ST SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013211",
            "telephone_number": "320-214-0044",
            "fax_number": "320-214-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 5TH ST SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562013211",
            "telephone_number": "320-214-0044",
            "fax_number": "320-214-0045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LAKE CHIROPRACTIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-05",
        "last_updated": "2008-06-02",
        "status": "A",
        "authorized_official_last_name": "HAEFNER",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-214-0044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MN",
            "license": "4176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meridian Disc Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Health Service Clinic/Center in Willmar, MN
• Providers in Willmar, MN by specialty
• Health Service Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; 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.