MEDICARE: NORTHWOODS CHIROPRACTIC P. A.

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	3138	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68D24NO	OTHER	MN	BCBS OFFICE ID #
2	68D25PE	OTHER	MN	BCBS INDIVIDUAL ID #

General Provider Information

NPI Number	:	1477610194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWOODS CHIROPRACTIC P. A.

Provider Business Mailing Address
First Line	:	13743 E SHORE RD
Second Line	:
City	:	CROSSLAKE
State	:	MN
Zip	:	56442-4033
Country	:	US
Telephone Number	:	218-692-1616
Fax Number	:	218-692-1626

Provider Business Practice Location Address
First Line	:	13743 E SHORE RD
Second Line	:
City	:	CROSSLAKE
State	:	MN
Zip	:	56442-4033
Country	:	US
Telephone Number	:	218-692-1616
Fax Number	:	218-692-1626

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANICIA GWEN PETERSON
Credential	:	D.C.
Telephone Number	:	218-692-1616

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

Similar Medicare Providers

1003973702 — DR. ANICIA GWEN PETERSON D.C.
Practice Location Address:

13743 E SHORE RD
CROSSLAKE, MN
56442-4033

Practice Phone: 218-692-1616
Practice Fax: 218-692-1626

1962464230 — DR. SARA MARIE LOKSTAD M.D.
Practice Location Address:

35205 COUNTY ROAD 3
CROSSLAKE, MN
56442-4057

Practice Phone: 218-692-1010
Practice Fax:

1003872540 — DR. ADRIENNE MILLIGAN PLATT CPNP
Practice Location Address:

36974 BONNIE LAKES RD
CROSSLAKE, MN
56442

Practice Phone: 816-835-0929
Practice Fax:

1396795092 — WELLNESSONE OF CROSSLAKE
Practice Location Address:

35272 COUNTY ROAD 3
CROSSLAKE, MN
56442-2804

Practice Phone: 218-692-3700
Practice Fax: 218-692-3700

1477509776 — ST. JOSEPH'S MEDICAL CENTER
Practice Location Address:

35205 COUNTY ROAD 3
CROSSLAKE, MN
56442-4057

Practice Phone: 218-692-1010
Practice Fax: 218-692-1013

1003965195 — LINDA LEWIS DDS
Practice Location Address:

35252 COUNTY ROAD 3
CROSSLAKE, MN
56442-2804

Practice Phone: 218-692-1522
Practice Fax: 218-692-1524

Directions to “NORTHWOODS CHIROPRACTIC P. A. ” Practice Location

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