Central Lakes Chiropractic Clinic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2218 Issued in MN

Legal business name

CENTRAL LAKES CHIROPRACTIC CLINIC PC

Practice address

510 22ND Ave E
Suite 701
Alexandria, MN 56308-4653

Phone

(320) 763-9711

Fax

(320) 763-9707

NPI assigned

Apr 19, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Barbara L. Dolezal, D.C.NPI 1053376459

Title

President

Phone

(320) 763-9711

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Practitioners 2

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

• Barbara L. Dolezal, D.C.

  • Chiropractor
  • Alexandria, MN
  • NPI 1053376459
  Medicare reassignment Care Compare group NPD Authorized official
• Derek Goracke, DC

  • Chiropractor
  • Alexandria, MN
  • NPI 1104398171
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1145404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392940800000",
    "number": "1902861339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 22ND AVE E",
            "address_2": "SUITE 701",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563084653",
            "telephone_number": "320-763-9711",
            "fax_number": "320-763-9707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 22ND AVE E",
            "address_2": "SUITE 701",
            "city": "ALEXANDRIA",
            "state": "MN",
            "postal_code": "563084653",
            "telephone_number": "320-763-9711",
            "fax_number": "320-763-9707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL LAKES CHIROPRACTIC CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-19",
        "last_updated": "2014-02-21",
        "status": "A",
        "authorized_official_last_name": "DOLEZAL",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "320-763-9711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "757827000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Louise Vano Carpenter
• Heidi Carstensen
• Julissa Celisvictoria
• Center for Pain Management Ambulatory Surgery, LTD
• Centracare Medical Supply LLC
• Central Lakes Mental Health
• Central Minnesota Pediatric Dentists PA
• Century Chiropractic Center, P.a.
• Gayle Lee Chamberlin, DC BS
• Alison F Chinn, M.D.

• Chiropractor in Alexandria, MN
• Providers in Alexandria, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2014; 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.