Green Lake Chiropractic, PA

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

4176 Issued in MN

Legal business name

GREEN LAKE CHIROPRACTIC, PA

Practice address

205 5TH St SW
Willmar, MN 56201-3211

Phone

(320) 214-0044

Fax

(320) 214-0045

NPI assigned

Feb 5, 2008

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.

Title

President

Phone

(320) 214-0044

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Meridian Disc Institute Doing business as

Locations

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACN GROUP",
            "identifier": "627686",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH SERVICE MGMT.",
            "identifier": "0868",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN BCBS",
            "identifier": "062M1GR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meridian Disc Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Sallie Graves
• Great River Endodontics, PA
• Greater Minnesota Family Services
• Michelle Lee Greydanus
• Jane Groen
• Breanna Mae Gronli, MSW, LICSW, SEP
• Gary J. Gronstedt, D.O.
• Abbey Guggisberg, LMFT

• 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.