St Bonifacius Chiropractic L.L.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

ST BONIFACIUS CHIROPRACTIC L.L.C.

Doing business as

St. Bonifacius Chiropractic

Practice address

4080 Tower St Ste 1080
St Bonifacius, MN 55375-1144

Phone

(952) 446-1800

Fax

(952) 446-1801

NPI assigned

Sep 20, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Chase M Martin, DCNPI 1972890291

Title

Owner

Phone

(701) 202-5963

Specialties & licenses 1

Addresses

Other names 1

• St. Bonifacius Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 1

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

• Chase Matthew Martin, D.C.

  • Chiropractor
  • St Bonifacius, MN
  • NPI 1972890291
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1537401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580256000000",
    "number": "1760966147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 268",
            "city": "ST BONIFACIUS",
            "state": "MN",
            "postal_code": "553750268",
            "telephone_number": "952-446-1800",
            "fax_number": "952-446-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 TOWER ST STE 1080",
            "city": "ST BONIFACIUS",
            "state": "MN",
            "postal_code": "553751144",
            "telephone_number": "952-446-1800",
            "fax_number": "952-446-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST BONIFACIUS CHIROPRACTIC L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-20",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "CHASE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "701-202-5963",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Bonifacius Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel Ray Miller, MA, LMFT
• Patti Jane Miller, M.A., L.P.
• Tricia Anne Miller, OTR/L
• Karen Moberg, M.ED, ATC
• Sonja Squiers, MS, LAT, ATC
• Nathan Michael Tellers, ATC
• Vibrant Health Family Chiropractic LLC

• Chiropractor in St Bonifacius, MN
• Providers in St Bonifacius, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.