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General NPI Number Information
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NPI Number | 1184708117
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Entity Type | Organization
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Legal Business Name | A CENTER FOR CHIROPRACTIC AND ACUPUNTURE PA
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 02/09/2017
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Provider Practice Location Address
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Address Line | 1803 WOODLANE DR
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City | WOODBURY
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State | MN
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Zip | 55125-2910
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Country | US
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Telephone | 651-739-2225
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Fax | 651-739-3313
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Provider Business Mailing Address
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Address Line | 1803 WOODLANE DR
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City | WOODBURY
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State | MN
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Zip | 55125-2910
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Country | US
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Telephone | 651-739-2225
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Fax | 651-739-3313
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DIANE LYNN JOHNSON
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Credential |
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Telephone | 651-739-2225
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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 | 3627687
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License Number State | MN
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