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NPI Code Detail

MEDICARE: ACQUA CHIROPRACTIC, LLC

MEDICARE: ACQUA CHIROPRACTIC, LLC
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
1111N00000XChiropractor5398MN

General Provider Information

NPI Number : 1710240296
Entity Type Code : Organization
Provider Name (Legal Business Name) : ACQUA CHIROPRACTIC, LLC
Provider Business Mailing Address
First Line : 4833 MINNETONKA BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-2214
Country : US
Telephone Number : 952-913-8687
Fax Number : 952-922-2335
Provider Business Practice Location Address
First Line : 4833 MINNETONKA BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-2214
Country : US
Telephone Number : 952-913-8687
Fax Number : 952-922-2335
Authorized Official
Title or Position : DOCTOR OF CHIROPRACTIC
Name : DR. RYAN REILLY
Credential : D.C.
Telephone Number : 952-913-8687
Provider Enumeration Date : 06/20/2012
Last Update Date : 06/20/2012

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Directions to “ACQUA CHIROPRACTIC, LLC ” Practice Location

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