Healthcare Provider Details

I. General information

NPI: 1215986757
Provider Name (Legal Business Name): HOPKINS SPINAL CARE P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10907 EXCELSIOR BLVD
HOPKINS MN
55343-3420
US

IV. Provider business mailing address

10907 EXCELSIOR BLVD
HOPKINS MN
55343-3420
US

V. Phone/Fax

Practice location:
  • Phone: 952-930-3303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LISA SMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 952-930-3303