Healthcare Provider Details

I. General information

NPI: 1467795393
Provider Name (Legal Business Name): R F SPINE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 NICOLLET AVE
RICHFIELD MN
55423-1614
US

IV. Provider business mailing address

6410 NICOLLET AVE
RICHFIELD MN
55423-1614
US

V. Phone/Fax

Practice location:
  • Phone: 612-886-2311
  • Fax: 612-886-2293
Mailing address:
  • Phone: 612-886-2311
  • Fax: 612-886-2293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5444
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number5444
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number908
License Number StateMN

VIII. Authorized Official

Name: DR. CHAD F AHMED
Title or Position: OWNER
Credential: DC
Phone: 612-886-2311