Healthcare Provider Details

I. General information

NPI: 1447654637
Provider Name (Legal Business Name): MIDWEST SPINE SOLUTIONS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2014
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 HENNEPIN AVE SUITE 255
MINNEAPOLIS MN
55408
US

IV. Provider business mailing address

4351 PARKLAWN AVE 201
EDINA MN
55435
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 Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5444
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5444
License Number StateMN

VIII. Authorized Official

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