NPIMap

Organization Active NPI

Jo G Theisen DC, PA

Doing business as Family Chiropractic Health Service

  • Chiropractor
  • Brooklyn Park, MN
National Provider Identifier
1952484602
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2599 Issued in MN
Legal business name
JO G THEISEN DC, PA
Doing business as
Family Chiropractic Health Service
Practice address
8465 W Broadway Ave
Brooklyn Park, MN 55445-2266
Phone
(763) 424-7750
Fax
(763) 424-3444
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Scott R Theisen
Title
Clinic Director
Phone
(763) 424-7750

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2599 MN Primary

Addresses

Primary practice location

8465 W Broadway Ave
Brooklyn Park, MN 55445-2266

Mailing address

8465 W Broadway Ave
Brooklyn Park, MN 55445-2266
Phone (763) 424-7750

Other names 1

  • Family Chiropractic Health Service Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061030000095 MN Part B Supplier - Clinic/Group Practice 7214934579 Receives reassigned benefits from 2 practitioners
Practice locations: Brooklyn Park, MN

National Provider Directory

National Provider Directory

Locations

8465 W Broadway Ave
Minneapolis, MN 55445
Phone (763) 424-7750

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1952484602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8465 W BROADWAY AVE",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452266",
            "telephone_number": "763-424-7750",
            "fax_number": "763-424-3444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8465 W BROADWAY AVE",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554452266",
            "telephone_number": "763-424-7750",
            "fax_number": "763-424-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JO G THEISEN DC, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "THEISEN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "763-424-7750"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "2599",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Chiropractic Health Service",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Family Chiropractic Health Service",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.