Individual provider Active NPI

Tim Alan Sebenaler, D.C.

  • Chiropractor
  • Chaska, MN
National Provider Identifier
1861427148
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2477 Issued in MN
Practice address
119 W 4TH St
Chaska, MN 55318-2085
Phone
(952) 448-9908
Fax
(952) 448-9472
NPI assigned
Jul 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2477 MN Primary

Addresses

Primary practice location

119 W 4TH St
Chaska, MN 55318-2085

Mailing address

119 W 4TH St
Chaska, MN 55318-2085
Phone (952) 448-9908

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050718000450 MN Practitioner - Chiropractic 6507893997 Practice locations: Chaska, MN

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Northwestern College of Chiropractic, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

119 W 4TH St
Suite 3
Chaska, MN 55318-2086
Phone (952) 448-9908

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2477MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Eastview Family Chiropractic Clinic Chiropractor Past Accepting new patients

Organizations & group practices 1

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": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861427148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 W 4TH ST",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553182085",
            "telephone_number": "952-448-9908",
            "fax_number": "952-448-9472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "119 W 4TH ST",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553182085",
            "telephone_number": "952-448-9908",
            "fax_number": "952-448-9472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEBENALER",
        "first_name": "TIM",
        "middle_name": "ALAN",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chaska, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.