INNER LIGHT CHIROPRACTIC, P.A. – Chiropractor, NPI 1396715686

INNER LIGHT CHIROPRACTIC, P.A. is a healthcare provider. based in Brooklyn park, Minnesota. specializing in Chiropractor. The organization holds a License No. 4717 (MN). The NPI Number for INNER LIGHT CHIROPRACTIC, P.A. is 1396715686

Main info

Organization
Name
INNER LIGHT CHIROPRACTIC, P.A.
NPI
1396715686
Phone
(763) 486-3945
Address
4630 97TH AVE N
Authorized Official
DR. RUSSELL S. DERHAK PRESIDENT D.C.
Enumeration Date
26 January 2006
Last Update Date
22 August 2020
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:20State licenses:1Digital endpointsOther names

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Provider Addresses for INNER LIGHT CHIROPRACTIC, P.A.

  • 97th Avenue North, Brooklyn Park, Hennepin County, Minnesota, 55443, United States

    BROOKLYN PARK, MN 55443

    Phone: (763) 486-3945

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2007-04-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2025-08-31 (284 days ago).

Enrollment records

1

Earliest due date

2025-08-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20070411000072OClinic/Group PracticeMN2025-08-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55443)

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Reviews

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Frequently asked questions

What is INNER LIGHT CHIROPRACTIC, P.A.'s NPI number?
INNER LIGHT CHIROPRACTIC, P.A.'s NPI is 1396715686 — the number used across U.S. healthcare to identify this provider.
Active or inactive — what applies to INNER LIGHT CHIROPRACTIC, P.A.?
You should see INNER LIGHT CHIROPRACTIC, P.A. as active in CMS-hosted NPPES data.
What area of care is associated with INNER LIGHT CHIROPRACTIC, P.A.?
INNER LIGHT CHIROPRACTIC, P.A.'s record emphasizes Chiropractor. Clinical services aligned with this taxonomy classification.
What practice footprint exists for INNER LIGHT CHIROPRACTIC, P.A.?
Travel planning: use Brooklyn Park, Minnesota as the reference point for INNER LIGHT CHIROPRACTIC, P.A., then confirm.
When was this NPI issued?
Enumeration for INNER LIGHT CHIROPRACTIC, P.A. is noted as January 26, 2006 where the registry provides it.

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