MEDICARE: FIRST CHOICE CHIROPRACTIC

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	261QH0100X	Health Service Clinic/Center		MN

General Provider Information

NPI Number	:	1285946186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	1214 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2761
Country	:	US
Telephone Number	:	612-284-5355
Fax Number	:	612-677-3483

Provider Business Practice Location Address
First Line	:	1214 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2761
Country	:	US
Telephone Number	:	612-284-5355
Fax Number	:	612-677-3483

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	DR. KRISTI ZIMMERMAN
Credential	:	D.C.
Telephone Number	:	612-284-5355

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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