1 Body Health and Fitness PA

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

3008 Issued in MN

Legal business name

1 BODY HEALTH AND FITNESS PA

Practice address

105 International Dr
Suite 121
Red Lake Falls, MN 56750-4665

Phone

(218) 253-2111

NPI assigned

Jun 13, 2008

Organization subpart

No

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

Authorized official

Name

Kevin Nelson

Title

Ceo

Phone

(218) 253-2111

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481846400000",
    "number": "1942460811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 INTERNATIONAL DR",
            "address_2": "SUITE 121",
            "city": "RED LAKE FALLS",
            "state": "MN",
            "postal_code": "567504665",
            "telephone_number": "218-253-2111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 INTERNATIONAL DR",
            "address_2": "SUITE 121",
            "city": "RED LAKE FALLS",
            "state": "MN",
            "postal_code": "567504665",
            "telephone_number": "218-253-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1 BODY HEALTH AND FITNESS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2016-12-16",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-253-2111"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4K044TH",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "822797011671",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Altru Health System (Altru Clinic - Red Lake Falls)
• Tia Michelle Gullickson, FNP-C
• Hillcrest Senior Living
• Ind School District 630
• Inspire Independence Therapy LLC

• Chiropractor in Red Lake Falls, MN
• Providers in Red Lake Falls, MN by specialty
• Chiropractor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.