MEDICARE: PRIVRATSKY CHIROPRACTIC PC

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	111NR0400X	Rehabilitation Chiropractor

General Provider Information

NPI Number	:	1447806260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVRATSKY CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1216 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2761
Country	:	US
Telephone Number	:	612-345-5376
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2761
Country	:	US
Telephone Number	:	612-345-5376
Fax Number	:	612-345-5495

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT NEIL PRIVRATSKY JR.
Credential	:	DC
Telephone Number	:	415-794-3081

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	08/16/2019

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