Healthcare Provider Details

I. General information

NPI: 1962611608
Provider Name (Legal Business Name): TOWN CENTER CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 W BROADWAY AVE SUITE D
ROBBINSDALE MN
55422-1858
US

IV. Provider business mailing address

4101 W BROADWAY AVE SUITE D
ROBBINSDALE MN
55422-1858
US

V. Phone/Fax

Practice location:
  • Phone: 763-533-9997
  • Fax: 763-533-6058
Mailing address:
  • Phone: 763-533-9997
  • Fax: 763-533-6058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NEVIN ROSENBERG
Title or Position: OWNER
Credential: DC
Phone: 763-533-9997