MEDICARE: INVER GROVE CHIROPRACTIC P A

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	261QP2000X	Physical Therapy Clinic/Center
2	111N00000X	Chiropractor	1591	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
2	59869IN	OTHER	MN	BLUE CROSS BLUE SHIELD
3	94265	OTHER	MN	MEDICA
4	230730	OTHER	MN	CHIRO CARE

General Provider Information

NPI Number	:	1194904417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INVER GROVE CHIROPRACTIC P A

Provider Business Mailing Address
First Line	:	2940 65TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2040
Country	:	US
Telephone Number	:	651-451-1012
Fax Number	:	651-453-1543

Provider Business Practice Location Address
First Line	:	2940 65TH ST E
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2040
Country	:	US
Telephone Number	:	651-451-1012
Fax Number	:	651-453-1543

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROSS DAVID CRAIN
Credential	:	D.C
Telephone Number	:	651-451-1012

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/26/2024

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Directions to “INVER GROVE CHIROPRACTIC P A ” Practice Location

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