MEDICARE: BREWER CORP PA

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	2026	MN

General Provider Information

NPI Number	:	1669763827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREWER CORP PA

Provider Business Mailing Address
First Line	:	3800 SHORELINE DR
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-9785
Country	:	US
Telephone Number	:	952-471-2555
Fax Number	:	952-471-2556

Provider Business Practice Location Address
First Line	:	3800 SHORELINE DR.
Second Line	:
City	:	WAYZATA
State	:	MN
Zip	:	55391-9785
Country	:	US
Telephone Number	:	952-471-2555
Fax Number	:	952-471-2556

Authorized Official
Title or Position	:	OWNER
Name	:	MARK E BREWER
Credential	:	D.C.
Telephone Number	:	952-471-2555

Provider Enumeration Date	:	04/22/2011
Last Update Date	:	04/22/2011

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