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General NPI Number Information
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NPI Number | 1073808788
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Entity Type | Organization
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Legal Business Name | TWIN LAKES CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 93 OAK AVE S SUITE 2
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City | ANNANDALE
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State | MN
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Zip | 55302-1205
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Country | US
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Telephone | 320-274-3499
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 95
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City | ANNANDALE
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State | MN
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Zip | 55302-0095
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Country | US
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Telephone | 320-274-3499
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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. CRAIG STEVEN JOHNSON
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Credential | D.C.
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Telephone | 612-298-0792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 5421
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License Number State | MN
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