Individual provider Active NPI

Jeffrey Wayne Danielson, DC

  • Chiropractor
  • Burnsville, MN
National Provider Identifier
1821006453
Registry record updated Feb 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3374 Issued in MN
Practice address
13955 W Preserve Blvd # 200
Burnsville, MN 55337-7733
Phone
(952) 890-0804
Fax
(952) 890-1095
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 3374 MN Primary

Addresses

Primary practice location

13955 W Preserve Blvd # 200
Burnsville, MN 55337-7733

Mailing address

13955 W Preserve Blvd # 200
Burnsville, MN 55337-7733
Phone (952) 890-0804

Other identifiers 2

IdentifierTypeStateIssuer
2613298-00MedicaidMN
45B78DAOtherMNBCBS ID NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120206000438 MN Practitioner - Chiropractic 7810971017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Los Angeles, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piff Holdings PCGroup PAC ID 0446473730, 4 clinicians

Practice addresses (Care Compare)

13955 W Preserve Blvd
Suite 200
Burnsville, MN 55337-7733
Phone (952) 890-0804

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3374MNMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Crown Capital Strategies LLC Current Accepting new patients
Piff Holdings, P.C. Chiropractor CurrentSince Apr 5, 2014 Accepting new patients

Locations

13955 W Preserve Blvd
Ste 200
Burnsville, MN 55337
Phone (952) 890-0804

Organizations & group practices 2

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328140800000",
    "number": "1821006453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13955 W PRESERVE BLVD # 200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553377733",
            "telephone_number": "952-890-0804",
            "fax_number": "952-890-1095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13955 W PRESERVE BLVD # 200",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553377733",
            "telephone_number": "952-890-0804",
            "fax_number": "952-890-1095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANIELSON",
        "first_name": "JEFFREY",
        "middle_name": "WAYNE",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2012-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2613298-00",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS ID NUMBER",
            "identifier": "45B78DA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2012; 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.