Healthcare Provider Details

I. General information

NPI: 1447806260
Provider Name (Legal Business Name): PRIVRATSKY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 W LAKE ST
MINNEAPOLIS MN
55408-2761
US

IV. Provider business mailing address

1216 W LAKE ST
MINNEAPOLIS MN
55408-2761
US

V. Phone/Fax

Practice location:
  • Phone: 612-345-5376
  • Fax: 612-345-5495
Mailing address:
  • Phone: 612-345-5376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT NEIL PRIVRATSKY JR.
Title or Position: PRESIDENT
Credential: DC
Phone: 415-794-3081