1245458652 NPI number — TWIN CITIES CHIROPRACTIC AND NUTRITION, P.L.L.C.

Table of content: (NPI 1245458652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245458652 NPI number — TWIN CITIES CHIROPRACTIC AND NUTRITION, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWIN CITIES CHIROPRACTIC AND NUTRITION, P.L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245458652
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3357 36TH AVENUE S.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55406-3135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-240-7133
Provider Business Mailing Address Fax Number:
612-233-5459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3357 36TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55406-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-240-7133
Provider Business Practice Location Address Fax Number:
612-233-5459
Provider Enumeration Date:
04/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOTTO
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-240-7133

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4648 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 121D0DO . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com