INNOVATIVE CHIROPRACTIC CENTER (NPI# 1790182335) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790182335 |
| Entity Type | Organization |
| Organization Name | INNOVATIVE CHIROPRACTIC CENTER |
| Practice Address |
201 D East Ave. Red Wing MN 55041 |
| Practice Telephone | 6514481481 |
| Mailing Telephone | 6514481481 |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2014-11-25 |
| Authorized Official Name | DR. RYAN SHANE LYSTAD (CO-OWNER) |
| Authorized Official Telephone | 6514481481 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | 5976 | MN | Chiropractic Providers |
| Y | 111N00000X | Chiropractor | 5977 | MN | Chiropractic Providers |
| Street Address |
201 D EAST AVE. |
| City | RED WING |
| State | MN |
| Zip Code | 55041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952708646 | Kaitlin Mccarthy | Chiropractor | 201 D East Ave., Red Wing, MN 55066 | 2014-11-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285136242 | Perry Dental, Ltd. | Dentist | 210 N. Lakeshore Dr., Lake City, MN 55041 | 2018-03-06 |
| 1245327147 | David F Valkos | Chiropractor | 106 So Washington St, Lake City, MN 55041 | 2006-10-10 |
| 1063441830 | Michael D Ackermann | Optometrist | 117 W Center St, Lake City, MN 55041 | 2006-07-02 |
| 1871945469 | Heidi Ann Eisenman | Nurse Practitioner | 500 W Grant St, Lake City, MN 55041 | 2016-07-07 |
| 1760668693 | Elizabeth Agnes Olson | Chiropractor | 106 S Washington St, Lake City, MN 55041-1034 | 2008-01-10 |
| 1194900936 | Valkos Chiropractic Office, LLC | Clinic/Center | 106 S Washington St, Lake City, MN 55041-1034 | 2007-12-28 |
| 1689650350 | Ann Marie Lowe | Family Medicine | 500 W Grant St, Lake City, MN 55041-1143 | 2005-12-15 |
| 1689280406 | Kelly Marie Kennedy | Pharmacist | 500 W Grant St, Lake City, MN 55041-1143 | 2020-09-17 |
| 1447863972 | Mayo Clinic Health System-lake City | Non-Pharmacy Dispensing Site | 500 W Grant St, Lake City, MN 55041-1143 | 2020-08-25 |
| 1124638341 | Rebekah Richter | Physical Therapist | 500 W Grant St, Lake City, MN 55041-1143 | 2020-08-03 |
| Find all providers in zip 55041 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964314 | Center for Natural Healthcare, Pllc | Chiropractor | 1626 W 3rd St, Red Wing, MN 55066-2086 | 2018-12-21 |
| 1184083586 | Vanessa Bohr | Chiropractor | 122 Tyler Rd S, Red Wing, MN 55066-1733 | 2016-02-15 |
| 1487775987 | Kayvon Behnam | Chiropractor | 104 Burnside Ave S, Red Wing, MN 55066-1928 | 2007-04-02 |
| 1992825517 | Joseph H. Sevlie | Chiropractor | 1626 W. 3rd St., Red Wing, MN 55066 | 2007-03-29 |
| 1487779534 | Brian Anthony Kroll | Chiropractor | 305 Bush St, Red Wing, MN 55066-2527 | 2007-03-20 |
| 1417024217 | Kevin Curtis Smith | Chiropractor | 212 Fulton, Red Wing, MN 55066 | 2006-11-29 |
| 1538233101 | Downtown Chiropractic Ltd. | Chiropractor | 212 Fulton St, Red Wing, MN 55066-2219 | 2006-11-17 |
| 1427143163 | Jennifer J Patterson | Chiropractor | 416 W 3rd St, Red Wing, MN 55066-2384 | 2006-10-04 |
| 1568476216 | Susan M Eisenmenger | Chiropractor | 424 W 5th St, Red Wing, MN 55066-2524 | 2006-07-28 |
| 1871551473 | Bernie Orders Finch | Chiropractor | 29218 Highway 58 Blvd, Red Wing, MN 55066-7407 | 2006-05-03 |
| Find all providers in RED WING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.