Healthcare Provider Details

I. General information

NPI: 1750673117
Provider Name (Legal Business Name): CHIROCENTER MN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 LYNDALE AVE S STE 100
MINNEAPOLIS MN
55403-3101
US

IV. Provider business mailing address

1936 LYNDALE AVE S STE 100
MINNEAPOLIS MN
55403-3101
US

V. Phone/Fax

Practice location:
  • Phone: 612-874-1313
  • Fax: 612-874-6767
Mailing address:
  • Phone: 612-874-1313
  • Fax: 612-874-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2266
License Number StateMN

VIII. Authorized Official

Name: DR. ELIIZABETH J BERG
Title or Position: OWNER
Credential: D.C.
Phone: 612-874-1313