Healthcare Provider Details

I. General information

NPI: 1144492083
Provider Name (Legal Business Name): TWIN CITIES SPINE & SPORTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6409 CITY WEST PKWY SUITE 100
EDEN PRAIRIE MN
55344-7845
US

IV. Provider business mailing address

6409 CITY WEST PKWY SUITE 100
EDEN PRAIRIE MN
55344-7845
US

V. Phone/Fax

Practice location:
  • Phone: 952-941-3311
  • Fax: 952-944-2004
Mailing address:
  • Phone: 952-941-3311
  • Fax: 952-944-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD A HILLS
Title or Position: CHIROPRACTOR, PHYSICAL THERAPIST
Credential:
Phone: 952-941-3311