Healthcare Provider Details

I. General information

NPI: 1063013340
Provider Name (Legal Business Name): PLYMOUTH CHIROCENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 VINEWOOD LN N STE 19
PLYMOUTH MN
55441-1155
US

IV. Provider business mailing address

3900 VINEWOOD LN N STE 19
PLYMOUTH MN
55441-1155
US

V. Phone/Fax

Practice location:
  • Phone: 763-559-9236
  • Fax: 763-559-4856
Mailing address:
  • Phone: 763-559-9236
  • Fax: 763-559-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN THOMAS ALLENBURG
Title or Position: PRESIDENT
Credential: DC
Phone: 952-212-7489