Healthcare Provider Details

I. General information

NPI: 1417001702
Provider Name (Legal Business Name): CHIROPRACTIC SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 2ND ST E SUITE 100
JORDAN MN
55352-1449
US

IV. Provider business mailing address

212 2ND ST E SUITE 100
JORDAN MN
55352-1449
US

V. Phone/Fax

Practice location:
  • Phone: 952-492-6363
  • Fax: 952-492-5129
Mailing address:
  • Phone: 952-492-6363
  • Fax: 952-492-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3717
License Number StateMN

VIII. Authorized Official

Name: DR. CHARLES R COOK
Title or Position: OWNER
Credential: DC
Phone: 952-492-6363