Northland Chiropractic Center PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

NORTHLAND CHIROPRACTIC CENTER PA

Practice address

516 Main Street East
Detroit Lakes, MN 56501

Phone

(218) 844-5050

Fax

(218) 844-5049

NPI assigned

Mar 27, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer Elyse Pedersen, DCNPI 1689759383

Title

Owner

Phone

(218) 844-5050

Specialties & licenses 2

Addresses

Other identifiers 3

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.

• Jennifer Elyse Pedersen, DC

  • Chiropractor
  • Detroit Lakes, MN
  • NPI 1689759383
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1821116682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 MAIN STREET EAST",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "56501",
            "telephone_number": "218-844-5050",
            "fax_number": "218-844-5049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 MAIN STREET EAST",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "56501",
            "telephone_number": "218-844-5050",
            "fax_number": "218-844-5049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND CHIROPRACTIC CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-27",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "ELYSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "218-844-5050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "242T6N0",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROCARE OF MN",
            "identifier": "647163",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020960100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renee Michelle Niemi
• Lorrae Nieves
• Julie Ann Nodsle, OTR/L
• Stephen P Nordmark, MD
• Michael J. Norgard, MD
• Christina M Norton, APRN, CNP
• Spencer Oen, PA-C
• Blayne Ohman
• Nikki Lynn Oliver, APRN, CNP
• Benjy Olsen, DPM

• Chiropractor in Detroit Lakes, MN
• Providers in Detroit Lakes, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; 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.