Healthcare Provider Details

I. General information

NPI: 1710902028
Provider Name (Legal Business Name): CENTRAL CHIROPRACTIC & ACUPUNCTURE, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 81ST AVE NE
SPRING LAKE PARK MN
55432-2116
US

IV. Provider business mailing address

1342 81ST AVE NE
SPRING LAKE PARK MN
55432-2116
US

V. Phone/Fax

Practice location:
  • Phone: 763-784-3916
  • Fax: 763-784-3829
Mailing address:
  • Phone: 763-784-3916
  • Fax: 763-784-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2616
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number114
License Number StateMN

VIII. Authorized Official

Name: DR. MICHAEL ALAN KOHOUT
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 763-784-3916