MEDICARE: PREMIER HEALTH OF COON RAPIDS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	5855	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073915732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER HEALTH OF COON RAPIDS, INC

Provider Business Mailing Address
First Line	:	3340 NORTHDALE BLVD NW
Second Line	:	SUITE 120
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-1622
Country	:	US
Telephone Number	:	763-270-5828
Fax Number	:	763-270-5849

Provider Business Practice Location Address
First Line	:	3340 NORTHDALE BLVD NW
Second Line	:	SUITE 120
City	:	COON RAPIDS
State	:	MN
Zip	:	55448-1622
Country	:	US
Telephone Number	:	763-270-5828
Fax Number	:	763-270-5849

Authorized Official
Title or Position	:	CO-OWNER
Name	:	DR. KELSEY CHMIEL
Credential	:	D.C.
Telephone Number	:	763-270-5828

Provider Enumeration Date	:	09/24/2014
Last Update Date	:	09/15/2020

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