MEDICARE: DR. CHAD PECKELS D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3944	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1095661	OTHER	MN	ARAZ
2	75250	OTHER	MN	HEALTHPARTNERS
3	53D95RE	OTHER	MN	BCBS
4	4487419	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1255426953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD PECKELS D.C.

Provider Business Mailing Address
First Line	:	5000 W 36TH ST STE 120
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-2758
Country	:	US
Telephone Number	:	612-922-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 W 36TH ST STE 120
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-2758
Country	:	US
Telephone Number	:	612-922-8100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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