Fishtrap Lake Enterprises INC.
Chiropractor in Burnsville, MN. Organization (NPI-2).
NPI number1497052898
StatusActive
Last updated in NPPESMar 6, 2012
Details
- NPI
- 1497052898
- Entity type
- Organization (NPI-2)
- Legal business name
- Fishtrap Lake Enterprises INC.
- Organization subpart
- No
- Enumeration date
- Feb 21, 2011
- Last updated
- Mar 6, 2012
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 111N00000X | Chiropractor | – | – | Yes |
Other names
- Hidden Valley Chiropractic (Doing Business As)
Practice location
3701 Highway 13 WBurnsville, MN 55337-1721
Phone 952-895-1120 · Fax 952-895-5377
Mailing address
3701 Highway 13 WBurnsville, MN 55337-1721
Phone 952-895-1120 · Fax 952-895-5377
Authorized official
Michael Edward Novak
Ceo
9528951120
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