Healthcare Provider Details

I. General information

NPI: 1932237187
Provider Name (Legal Business Name): SPINAL REHAB CLINICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N BENTON DR STE 105
SAUK RAPIDS MN
56379-1574
US

IV. Provider business mailing address

225 N BENTON DR STE 105
SAUK RAPIDS MN
56379-1574
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-2225
  • Fax: 320-252-2159
Mailing address:
  • Phone: 320-252-2225
  • Fax: 320-252-2159

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. DANIEL T CARLSON
Title or Position: CEO
Credential: DC
Phone: 320-252-2225