Healthcare Provider Details

I. General information

NPI: 1992941769
Provider Name (Legal Business Name): ADVANCED INJURY SPECIALISTS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 EXCELSIOR BLVD SUITE 132
ST LOUIS PARK MN
55416-2906
US

IV. Provider business mailing address

5115 EXCELSIOR BLVD SUITE 132
ST LOUIS PARK MN
55416-2906
US

V. Phone/Fax

Practice location:
  • Phone: 952-232-5272
  • Fax: 952-400-5699
Mailing address:
  • Phone: 952-232-5272
  • Fax: 952-400-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4487
License Number StateMN

VIII. Authorized Official

Name: DR. SCOTT A. ALLAN
Title or Position: OWNER / CHIROPRACTOR
Credential: D.C.
Phone: 952-232-5272