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General NPI Number Information
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NPI Number | 1093864050
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC REHABILITATION CENTER LLC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9900 VALLEY CREEK RD #145
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 651-734-1123
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Fax | 651-734-1109
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Provider Business Mailing Address
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Address Line | 9900 VALLEY CREEK RD #145
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City | WOODBURY
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State | MN
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Zip | 55125
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Country | US
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Telephone | 651-734-1123
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Fax | 651-734-1109
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Authorized Official
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Title or Position | OWNER CEO
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Name | DR. JESSE JEROD CRANE
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Credential | DC
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Telephone | 651-734-1123
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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 | 4269
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3831
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License Number State | MN
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