NPIMap

Organization Active NPI

City Lakes Chiropractic PA

  • Chiropractor
  • Minneapolis, MN
National Provider Identifier
1992929541
Registry record updated Jan 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3363 Issued in MN
Legal business name
CITY LAKES CHIROPRACTIC PA
Practice address
2903 E 42ND Street
Minneapolis, MN 55406
Phone
(612) 722-2147
Fax
(612) 722-1581
NPI assigned
Apr 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2013

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

Authorized official

Name
Dr. James A Anderson, D.C.NPI 1013071943
Title
Owner
Phone
(612) 722-2147

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 3363 MN Primary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 508 MN

Addresses

Primary practice location

2903 E 42ND Street
Minneapolis, MN 55406

Mailing address

2903 E 42ND Street
Minneapolis, MN 55406
Phone (612) 722-2147

Other identifiers 2

IdentifierTypeStateIssuer
5374227-00MedicaidMN
43F05ANOtherMNBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040312000526 MN Part B Supplier - Clinic/Group Practice 9537058003 Receives reassigned benefits from 3 practitioners
Practice locations: Minneapolis, MN

National Provider Directory

National Provider Directory

Locations

2903 E 42nd St
Minneapolis, MN 55406
Phone (612) 722-2147

Practitioners & affiliated clinicians

Practitioners 6

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": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359331200000",
    "number": "1992929541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2903 E 42ND STREET",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55406",
            "telephone_number": "612-722-2147",
            "fax_number": "612-722-1581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2903 E 42ND STREET",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55406",
            "telephone_number": "612-722-2147",
            "fax_number": "612-722-1581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY LAKES CHIROPRACTIC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2013-01-28",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-722-2147",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3363",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "508",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5374227-00",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "43F05AN",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2013; 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.