Healthcare Provider Details

I. General information

NPI: 1265614242
Provider Name (Legal Business Name): ADVACARE CLINICS,LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 AMERICAN BLVD W STE.945
BLOOMINGTON MN
55437-1108
US

IV. Provider business mailing address

5001 AMERICAN BLVD W STE.945
BLOOMINGTON MN
55437-1108
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-6653
  • Fax: 952-835-3895
Mailing address:
  • Phone: 952-835-6653
  • Fax: 952-835-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number401
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS JOHN LENSELINK
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 952-835-6653