Individual provider Active NPI

Justin Anthony Fritz, D.C.

  • Chiropractor
  • Woodbury, MN
National Provider Identifier
1760787139
Registry record updated Sep 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5453 Issued in MN
Practice address
1625 Radio Dr
Suite 160
Woodbury, MN 55125-9407
Phone
(651) 731-5124
Fax
(651) 731-0509
NPI assigned
Jan 17, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5453 MN Primary

Addresses

Primary practice location

1625 Radio Dr
Suite 160
Woodbury, MN 55125-9407

Mailing address

1625 Radio Dr
Suite 160
Woodbury, MN 55125-9407
Phone (651) 731-5124

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110413000738 MN Practitioner - Chiropractic 6305020421

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 2010
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1625 Radio Dr
Woodbury, MN 55125-9407

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5453MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Wedgewood Chiropractic, P.a. Chiropractor Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1295222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378339200000",
    "number": "1760787139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 RADIO DR",
            "address_2": "SUITE 160",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551259407",
            "telephone_number": "651-731-5124",
            "fax_number": "651-731-0509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 RADIO DR",
            "address_2": "SUITE 160",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551259407",
            "telephone_number": "651-731-5124",
            "fax_number": "651-731-0509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRITZ",
        "first_name": "JUSTIN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-17",
        "last_updated": "2013-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; 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.