Healthcare Provider Details

I. General information

NPI: 1992803548
Provider Name (Legal Business Name): BRENT JAMES CHARLES ROBINSON D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 LEXINGTON AVE N
ROSEVILLE MN
55113-6516
US

IV. Provider business mailing address

1704 LEXINGTON AVE N
ROSEVILLE MN
55113-6514
US

V. Phone/Fax

Practice location:
  • Phone: 651-487-5950
  • Fax: 651-487-6016
Mailing address:
  • Phone: 651-779-5998
  • Fax: 651-789-0809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4085
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: