Willow Creek Chiropractic, PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3281 Issued in MN

Legal business name

WILLOW CREEK CHIROPRACTIC, PA

Practice address

5922 Lexington Ave N
Shoreview, MN 55126-5604

Phone

(651) 784-3396

Fax

(651) 784-7247

NPI assigned

Nov 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Michael Douglas Head, DC

Title

President

Phone

(651) 784-3396

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lynnsey Nicole Jepsen, D.C.

  • Chiropractor
  • Rogers, MN
  • NPI 1801025044
  Medicare reassignment NPD
• Andrew Burton Krueger, D.C.

  • Chiropractor
  • Baxter, MN
  • NPI 1205234598
  Medicare reassignment NPD
• Robert O Berkseth, MD

  • Nephrology Physician
  • Minneapolis, MN
  • NPI 1891748646
  NPD (past)
• Michael George Kuderer, D.C.

  • Chiropractor
  • Stewartville, MN
  • NPI 1578722047
  NPD (past)
• Lori Lynn Marek, D.C.

  • Chiropractor
  • Shoreview, MN
  • NPI 1669551586
  NPD (past)

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219795200000",
    "number": "1831278449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5922 LEXINGTON AVE N",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551265604",
            "telephone_number": "651-784-3396",
            "fax_number": "651-784-7247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5922 LEXINGTON AVE N",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551265604",
            "telephone_number": "651-784-3396",
            "fax_number": "651-784-7247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW CREEK CHIROPRACTIC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2008-08-27",
        "status": "A",
        "authorized_official_last_name": "HEAD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-784-3396",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7711328-00",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBC OF MN CLINIC ID",
            "identifier": "35P22WI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "4400056",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVID PROVIDER NUM",
            "identifier": "35923HE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN FOR HEALTHPARTNERS",
            "identifier": "79279",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCMI ID",
            "identifier": "231934",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Azra Weber, M.D.
• Robert R Weber, MD
• Wholistic Counseling and Coaching Services
• Wholistic Counseling and Coaching Services
• Mark Robert Wilcox, DPT
• Natalie Rene Wilmes, OTR/L
• Woodcrest Counseling, Inc
• Jacob Woolley
• Jeff Worley, LICSW
• Janet Xiong

• Chiropractor in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; 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.