Innovative Chiropractic Center

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5977 Issued in MN

Legal business name

INNOVATIVE CHIROPRACTIC CENTER

Practice address

201 D East Ave.
Red Wing, MN 55041

Phone

(651) 448-1481

NPI assigned

Nov 25, 2014

Last updated

Nov 25, 2014By 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. Ryan Shane Lystad, D.C.

Title

Co-Owner

Phone

(651) 448-1481

Specialties & licenses 2

Addresses

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.

• Kaitlin Lystad, DC, IBCLC

  • Lactation Consultant (Non-RN)
  • Red Wing, MN
  • NPI 1952708646

  Chiropractor

  NPD (past)

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1790182335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 D EAST AVE.",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "55041",
            "telephone_number": "651-448-1481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 D EAST AVE.",
            "city": "RED WING",
            "state": "MN",
            "postal_code": "55041",
            "telephone_number": "651-448-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE CHIROPRACTIC CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-25",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "LYSTAD",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "651-448-1481",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5976",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5977",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Everett M Hughes, MD
• Matthew Humphrey
• Betsy Ann Hundertmark, CRNA
• Whitney J Huppert-Howe
• Abrianna Cyann Ingram
• Margaret Mary Irons
• Paul M Irwin
• Taylor R Irwin, PT, DPT
• George Edward Jackish, M.D.
• Sydney Jacobson

• Chiropractor in Red Wing, MN
• Providers in Red Wing, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.