Active NPI
Benjamin J Gavin, DC
- Chiropractor
- White Bear Lake, MN
National Provider Identifier
1801325873
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 6389
- Practice address
- 4801 Highway 61 N Ste 105
White Bear Lake, MN 55110-2748 - Phone
- (651) 762-5433
- NPI assigned
- Jun 5, 2017
- 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 | 6389 | MN | Primary |
Addresses
Primary practice location
4801 Highway 61 N Ste 105
White Bear Lake, MN 55110-2748
Mailing address
4801 Highway 61 N Ste 105
White Bear Lake, MN 55110-2748
Phone (651) 762-5433
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180206000786 | MN | Practitioner - Chiropractic | 4486914777 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496620800000",
"number": "1801325873",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 HIGHWAY 61 N STE 105",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551102748",
"telephone_number": "651-762-5433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 HIGHWAY 61 N STE 105",
"city": "WHITE BEAR LAKE",
"state": "MN",
"postal_code": "551102748",
"telephone_number": "651-762-5433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "BENJAMIN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-05",
"last_updated": "2017-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "6389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in White Bear Lake, MN
- Jill Marie Friedrichs, D.C.
- Jennifer Marie Frison, OTR/L
- Jillian Alexxis Garies
- Margaret Gast, MD
- Valerie Jeanne Gauster
- Chalchisa Geleta, PHARMD
- Gem Health Sleep Services of Kansas PA
- Gem Health Sleep Services of Kansas PA
- Gem Health Specialty Sleep Services of Colorado, P.C.
- Gem Health Specialty Sleep Services of Colorado, P.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2017; 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.