MEDICARE: B P CHIROPRACTIC CLINIC

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	4842	MN

General Provider Information

NPI Number	:	1326445826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B P CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	3330 BROOKDALE DR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2863
Country	:	US
Telephone Number	:	763-432-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	3330 BROOKDALE DR N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55443-2863
Country	:	US
Telephone Number	:	763-432-5073
Fax Number	:

Authorized Official
Title or Position	:	CHIEF MANAGER/SECRETARY
Name	:	TONY P. WANGERIN
Credential	:	D.C.
Telephone Number	:	763-432-5073

Provider Enumeration Date	:	11/26/2014
Last Update Date	:	11/26/2014

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