Gabriel L Wiener, DC
Individual provider Active NPI Chiropractor · Fosston, MN
NPI 1891794293 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891794293
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 4402 (MN)
- Practice address
- 104 Johnson Ave N
Fosston, MN 56542-1328 - Phone
- (218) 435-6186
- Fax
- (218) 435-6181
- NPI assigned
- Jul 18, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Northwestern College of Chiropractic, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
104 Johnson Ave N
Fosston, MN 56542-1328
Phone (218) 435-6186
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111207000651 | MN | Practitioner - Chiropractic | 6002081775 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4402 | MN | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fosston Chiropractic Clinic, P.a. | Chiropractor | Current |
Accepting new patients |
Locations
104 Johnson Ave N
Fosston, MN 56542
Phone (218) 435-6186
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4402 | MN | Yes |
Addresses
Primary practice location
104 Johnson Ave N
Fosston, MN 56542-1328
Mailing address
104 Johnson Ave N
Fosston, MN 56542-1328
Phone (218) 435-6186
Other providers in Fosston, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.