1. Home
  2. Directory
  3. Minnesota
  4. Burnsville
  5. Chiropractor
  6. NPI Profile

EAGLE TRACE WELLNESS CENTER, PA
NPI 1790932390
Chiropractor in Burnsville, MN

Active since August 26, 2008
12002 COUNTY ROAD 11, BURNSVILLE, MN 55337(952) 808-2922(952) 808-2910 Get Directions Write a Review

NPPES record last updated: August 26, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Eagle Trace Wellness Center, Pa NPPES

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

EAGLE TRACE WELLNESS CENTER, PA (NPI 1790932390) is a healthcare organization registered as a chiropractor in Burnsville, Minnesota and active in the NPI registry since August 2008. The organization lists Elisa Marie Kensinger, Vice President, Secretary, Treasure, as its authorized official.

NPPES Registry Identity

NPI1790932390
Entity TypeOrganization
Primary Taxonomy111N00000X
Legal Business NameEAGLE TRACE WELLNESS CENTER, PA
Location Address12002 COUNTY ROAD 11Burnsville, MN 55337-3016
Mailing Address12002 County Road 11Burnsville, MN 55337-3016 · (952) 808-2922 · Fax (952) 808-2910
Phone(952) 808-2922
Fax(952) 808-2910
Organization SubpartNo
Authorized OfficialElisa Marie KensingerVice President, Secretary, Treasure · (952) 808-2922
Enumeration DateAugust 26, 2008
✔ NPI 1790932390 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyChiropractorChiropractic Providers
Taxonomy Code111N00000X
Licenses✔ Licensed in MN · 5077✔ Licensed in MN · 5104
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.
Also ListedAcupuncturistTaxonomy 171100000X · License 832 (MN)
12002 COUNTY ROAD 11, Burnsville, MN 55337
Open in Google Maps ↗

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 MULTIPLE SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Eagle Trace Wellness Center, Pa 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 Eagle Trace Wellness Center, PA, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jeffrey Plaster, DC
Chiropractic
NPI 1184146383
12002 COUNTY ROAD 11
Burnsville, MN 55337
(763) 898-3517
✔ 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 Eagle Trace Wellness Center, PA's NPI number?

The NPI number for Eagle Trace Wellness Center, PA is 1790932390. It was assigned to this organization in the NPPES registry on August 26, 2008.

Where is Eagle Trace Wellness Center, PA located?

Eagle Trace Wellness Center, PA is located at 12002 County Road 11, Burnsville, MN 55337. The listed phone number is (952) 808-2922.

What is Eagle Trace Wellness Center, PA's specialty?

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

Is Eagle Trace Wellness Center, PA enrolled in Medicare?

Yes. Eagle Trace Wellness Center, PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Eagle Trace Wellness Center, PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Chiropractic) reassigns their Medicare billing to Eagle Trace Wellness Center, PA. 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.

When was this NPI record last updated?

The NPPES record for Eagle Trace Wellness Center, PA was last updated on August 26, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.