Active NPI
Edward Leslie Requet, DC
- Chiropractor
- Chanhassen, MN
National Provider Identifier
1790735488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- MN3177
- Practice address
- 600 Market Street
Suite 260 Requet Chiropractic Wellness Center
Chanhassen, MN 55317 - Phone
- (952) 975-2959
- Fax
- (952) 975-2973
- NPI assigned
- May 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | MN3177 | MN | Primary |
Addresses
Primary practice location
600 Market Street
Suite 260 Requet Chiropractic Wellness Center
Chanhassen, MN 55317
Mailing address
600 Market Street
Suite 260
Chanhassen, MN 55317
Phone (952) 975-2959
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4C666RE | Other | MN | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MN3177 | MN | MD | Counseling Psychologist |
| 3177 | MN | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297209600000",
"number": "1790735488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 MARKET STREET",
"address_2": "SUITE 260",
"city": "CHANHASSEN",
"state": "MN",
"postal_code": "55317",
"telephone_number": "952-975-2959",
"fax_number": "952-975-2973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 MARKET STREET",
"address_2": "SUITE 260 REQUET CHIROPRACTIC WELLNESS CENTER",
"city": "CHANHASSEN",
"state": "MN",
"postal_code": "55317",
"telephone_number": "952-975-2959",
"fax_number": "952-975-2973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REQUET",
"first_name": "EDWARD",
"middle_name": "LESLIE",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-11",
"last_updated": "2011-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "MN3177",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "4C666RE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chanhassen, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.