Active NPI
Virak Sotonn, D.C
- Chiropractor
- Bloomington, MN
National Provider Identifier
1972643765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Chiropractor
- License
- 4264
- Practice address
- 9217 17TH Ave S
Suite 120
Bloomington, MN 55425-2373 - Phone
- (952) 881-0767
- Fax
- (952) 881-0806
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 4264 | MN | Primary |
Addresses
Primary practice location
9217 17TH Ave S
Suite 120
Bloomington, MN 55425-2373
Mailing address
9217 17TH Ave S
Suite 120
Bloomington, MN 55425-2373
Phone (952) 881-0767
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83G93AP | Other | MN | BCBS CONTRACTING PROVIDER |
| 83G52SO | Other | MN | BCBS INDIVIDUAL PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4264 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972643765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9217 17TH AVE S",
"address_2": "SUITE 120",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554252373",
"telephone_number": "952-881-0767",
"fax_number": "952-881-0806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9217 17TH AVE S",
"address_2": "SUITE 120",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554252373",
"telephone_number": "952-881-0767",
"fax_number": "952-881-0806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOTONN",
"first_name": "VIRAK",
"name_prefix": "Dr.",
"credential": "D.C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "111N00000X",
"taxonomy_group": "",
"desc": "Chiropractor",
"state": "MN",
"license": "4264",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS CONTRACTING PROVIDER",
"identifier": "83G93AP",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS INDIVIDUAL PROVIDER",
"identifier": "83G52SO",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.