MALLORI BETH DOMBROCK, D.C. — NPI 1124386172 (Licensed & Credentialed Chiropractic Providers — Chiropractor, Pediatric Chiropractor in EXCELSIOR, MN)

CMS-1500 Box 24J / 33a • NPI

1124386172

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

111NP0017X (CMS 35)

Licensed & Credentialed Chiropractic Providers — Chiropractor, Pediatric Chiropractor

Box 32 Service Location & ZIP+4

21450 HIGHWAY 7, EXCELSIOR, MN, 55331-7205

✓ 9-Digit EDI 837 ZIP+4 (55331-7205)

Practice Phone & Referral Fax

(952) 474-9393

Fax: (952) 474-2375

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1124386172 (MALLORI BETH DOMBROCK, D.C.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1124386172` (NPI-1 Individual Practitioner)
Provider / Legal Name	MALLORI BETH DOMBROCK, D.C.
Plain-English Specialty	Licensed & Credentialed Chiropractic Providers — Chiropractor, Pediatric Chiropractor NUCC Code: `111NP0017X` (Chiropractor, Pediatric Chiropractor)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	21450 HIGHWAY 7, EXCELSIOR, MN, 55331-7205
Practice Telephone / Fax	Tel: (952) 474-9393 \| Fax: (952) 474-2375
Administrative Mailing Address	21450 HIGHWAY 7, EXCELSIOR, MN, 55331-7205
Enumeration & Last Sync	Enumerated: 2012-04-27 \| CMS Record Updated: 2018-09-14

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

21450 HIGHWAY 7, EXCELSIOR, MN, 55331-7205

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Plain-English Taxonomy & CMS Crosswalk (111NP0017X)

What Does Taxonomy Code 111NP0017X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 111NP0017X translates to:
"Licensed & Credentialed Chiropractic Providers — Chiropractor, Pediatric Chiropractor"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 35 (Chiropractic)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Chiropractor, Pediatric Chiropractor for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MALLORI BETH DOMBROCK, D.C.)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`111NP0017X` — Chiropractor, Pediatric Chiropractor Plain English: Licensed & Credentialed Chiropractic Providers — Chiropractor, Pediatric Chiropractor	State: MN \| License: `5909` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MALLORI BETH DOMBROCK, D.C. (NPI #1124386172)