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HEALTHSOURCE OF WHITE BEAR LAKE, PLLC
NPI 1073767372
Chiropractor in White Bear Lake, MN

Active since November 13, 2008
4801 HIGHWAY 61 N, 105, WHITE BEAR LAKE, MN 55110(651) 762-5433(651) 762-7504 Get Directions Write a Review

NPPES record last updated: February 12, 2010. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Healthsource Of White Bear Lake, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEALTHSOURCE OF WHITE BEAR LAKE, PLLC (NPI 1073767372) is a healthcare organization registered as a chiropractor in White Bear Lake, Minnesota and active in the NPI registry since November 2008. The organization lists Michael Leo Dixon, Chiropractor, as its authorized official.

NPPES Registry Identity

NPI1073767372
Entity TypeOrganization
Primary Taxonomy111N00000X
Legal Business NameHEALTHSOURCE OF WHITE BEAR LAKE, PLLC
Location Address4801 HIGHWAY 61 N, 105White Bear Lake, MN 55110-2737
Mailing Address4801 Highway 61 N, 105White Bear Lake, MN 55110-2737 · (651) 762-5433 · Fax (651) 762-7504
Phone(651) 762-5433
Fax(651) 762-7504
Organization SubpartNo
Authorized OfficialMichael Leo DixonChiropractor · (651) 762-5433
Enumeration DateNovember 13, 2008
Last NPPES UpdateFebruary 12, 2010
✔ NPI 1073767372 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
License✔ Licensed in MN · 5114
Definition
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.
4801 HIGHWAY 61 N, White Bear Lake, MN 55110
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Healthsource Of White Bear Lake, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Healthsource Of White Bear Lake, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Ty Paulick, D.C.
Chiropractic
NPI 1902071285
4801 HIGHWAY 61 N SUITE 105
White Bear Lake, MN 55110
(651) 762-5433
✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Healthsource Of White Bear Lake, PLLC's NPI number?

The NPI number for Healthsource Of White Bear Lake, PLLC is 1073767372. It was assigned to this organization in the NPPES registry on November 13, 2008.

Where is Healthsource Of White Bear Lake, PLLC located?

Healthsource Of White Bear Lake, PLLC is located at 4801 Highway 61 N 105, White Bear Lake, MN 55110. The listed phone number is (651) 762-5433.

What is Healthsource Of White Bear Lake, PLLC's specialty?

The primary specialty registered for this NPI is Chiropractor with taxonomy code 111N00000X.

Is Healthsource Of White Bear Lake, PLLC enrolled in Medicare?

Yes. Healthsource Of White Bear Lake, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Healthsource Of White Bear Lake, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to Healthsource Of White Bear Lake, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Healthsource Of White Bear Lake, PLLC accept?

Health plans from HealthPartners list Healthsource Of White Bear Lake, PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Healthsource Of White Bear Lake, PLLC was last updated on February 12, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.