Healthcare Provider Details

I. General information

NPI: 1972926707
Provider Name (Legal Business Name): MINNESOTA SPINE AND PAIN INSTITUTE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5174 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421
US

IV. Provider business mailing address

5174 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421
US

V. Phone/Fax

Practice location:
  • Phone: 651-331-1460
  • Fax:
Mailing address:
  • Phone: 651-331-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5444
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5444
License Number StateMN

VIII. Authorized Official

Name: DR. CHAD F AHMED
Title or Position: OWNER
Credential: DC
Phone: 651-331-1460