Healthcare Provider Details

I. General information

NPI: 1376775049
Provider Name (Legal Business Name): METRO INJURY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 HIGHWAY 100 S
ST LOUIS PARK MN
55416-4791
US

IV. Provider business mailing address

2460 HIGHWAY 100 S
ST LOUIS PARK MN
55416-4791
US

V. Phone/Fax

Practice location:
  • Phone: 952-922-3111
  • Fax: 952-922-0999
Mailing address:
  • Phone: 952-922-3111
  • Fax: 952-922-0999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LISA HUSEBOE
Title or Position: PRESIDENT
Credential: D.C.
Phone: 954-410-2999