Itasca Chiropractic Center, P.C.

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

3641 Issued in MN

Legal business name

ITASCA CHIROPRACTIC CENTER, P.C.

Practice address

801 NE 4TH St
Grand Rapids, MN 55744-3106

Phone

(218) 326-1732

Fax

(218) 327-3415

NPI assigned

Aug 26, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Donald Andrew Anderson, D.C.NPI 1407932429

Title

Doctor of Chiropractic

Phone

(218) 326-1732

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 6

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

• Donald Andrew Anderson, D.C.

  • Chiropractor
  • Grand Rapids, MN
  • NPI 1407932429
  Medicare reassignment NPD Authorized official
• James Dale Christian, MS. ED., LMFT

  • Mental Health Counselor
  • Grand Rapids, MN
  • NPI 1548699986
  NPD (past)
• Stephanie Lyn Downing

  • Professional Counselor
  • Grand Rapids, MN
  • NPI 1427850544
  NPD (past)
• Lauren Elizabeth Flood Miley, LMFT

  • Marriage & Family Therapist
  • Grand Rapids, MN
  • NPI 1164941316
  NPD (past)
• Anna M Rajala

  • Professional Counselor
  • Grand Rapids, MN
  • NPI 1770389256
  NPD (past)
• Linh Scally, MSW, LICSW

  • Clinical Social Worker
  • Grand Rapids, MN
  • NPI 1316225527
  NPD (past)

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1861708992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 NE 4TH ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443106",
            "telephone_number": "218-326-1732",
            "fax_number": "218-327-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 NE 4TH ST",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557443106",
            "telephone_number": "218-326-1732",
            "fax_number": "218-327-3415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ITASCA CHIROPRACTIC CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-26",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "218-326-1732",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "MN",
            "license": "3641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denise Ann Hove, CCC/AUD
• Christina Marie Hubred, A D.T., DH
• Kerrie Rae Humble, MSW, LICSW
• Philip Bruce Imholte, M.D.
• Ind School District 318
• Itasca County Family Young Men'S Christian Association, Inc.
• Itasca Nursing Home
• Itasca Psychiatric Services Inc
• Itasca Surgical Clinic, PA
• J & L Urevig Inc

• Preferred Provider Organization in Grand Rapids, MN
• Providers in Grand Rapids, MN by specialty
• Preferred Provider Organization in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; 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.