Healthcare Provider Details

I. General information

NPI: 1841492428
Provider Name (Legal Business Name): CHIROPRACTIC ADVANTAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 PENN AVE S SUITE 116
BLOOMINGTON MN
55431-2068
US

IV. Provider business mailing address

8900 PENN AVE S 116
BLOOMINGTON MN
55431-2068
US

V. Phone/Fax

Practice location:
  • Phone: 952-884-3700
  • Fax: 612-656-0550
Mailing address:
  • Phone: 952-884-3700
  • Fax: 612-656-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3278
License Number StateMN

VIII. Authorized Official

Name: BRIAN S ELIJAH
Title or Position: OWNER PRESIDENT
Credential:
Phone: 952-884-3700