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General NPI Number Information
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NPI Number | 1033565510
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Entity Type | Organization
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Legal Business Name | MINNESOTA DISC REPLACEMENT AND SPINE RESTORATION CENTER
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/13/2016
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Provider Practice Location Address
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Address Line | 4444 76 ST #700
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 612-888-1433
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Fax |
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Provider Business Mailing Address
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Address Line | 6 RED FOREST LN
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City | NORTH OAKS
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State | MN
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Zip | 55127-6352
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Country | US
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Telephone | 612-888-1433
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYNN M MILLER
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Credential | D.O.
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Telephone | 612-888-1433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 50690
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License Number State | MN
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