Kevin Connery, DC
Individual provider Active NPI Chiropractor · Long Lake, MN
NPI 1891679262 · NPPES record last updated Jul 31, 2025
Key facts
- NPI
- 1891679262
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 7365 (MN)
- Practice address
- 1865 W Wayzata Blvd Ste 200
Long Lake, MN 55356-4100 - Phone
- (952) 473-3588
- NPI assigned
- Jul 31, 2025
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1865 W Wayzata Blvd
Suite 200
Long Lake, MN 55356-4100
460 5TH Ave N Apt
Suite 110
Hopkins, MN 55343-7297
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250814001432 | MN | Practitioner - Chiropractic | 5395244743 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7365 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chirocenter Inc. | Chiropractor | Current |
Accepting new patients |
| Chirocenter MN, Inc. | Chiropractor | Past |
Accepting new patients |
Locations
1865 W Wayzata Blvd
Ste 200
Long Lake, MN 55356
Phone (612) 476-1414
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 7365 | MN | Yes |
Addresses
Primary practice location
1865 W Wayzata Blvd Ste 200
Long Lake, MN 55356-4100
Mailing address
1865 W Wayzata Blvd Ste 200
Long Lake, MN 55356-4100
Phone (952) 473-3588
Other providers in Long Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.