Ty Evan Paulick, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5105 Issued in MN

Practice address

4801 Highway 61 N
Suite 105
White Bear Lake, MN 55110-2737

Phone

(651) 762-5433

Fax

(651) 762-7504

NPI assigned

Apr 28, 2008

Last updated

Feb 10, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Healthsource of White Bear Lake, PLLC

  • Chiropractor
  • White Bear Lake, MN
  • NPI 1073767372
  Medicare reassignment NPD
• Advanced Chiropractic Health PA

  • Chiropractor
  • Plymouth, MN
  • NPI 1568679264
  NPD (past)

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265760000000",
    "number": "1902071285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 HIGHWAY 61 N",
            "address_2": "SUITE 105",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102737",
            "telephone_number": "651-762-5433",
            "fax_number": "651-762-7504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 HIGHWAY 61 N",
            "address_2": "SUITE 105",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551102737",
            "telephone_number": "651-762-5433",
            "fax_number": "651-762-7504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULICK",
        "first_name": "TY",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-28",
        "last_updated": "2010-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "5105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "350004088",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Victoria Rose Palme, PA-C
• Mary M Paquette, MD
• Matthew J Paquette, MD
• Emea Pauline Hipolito Parungao
• Melissa Pascoe, LGSW
• Peace of Mind Home Care, LLC
• Peddycoart Chiropractic Inc.
• Brenwyn Anne Lisa Peddycoart, DC
• Teresa A Pena, MD
• Kathleen Jo Penn, LPCC

• Chiropractor in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2010; 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.