=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184766842
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANOKA-ANDOVER CHIROPRACTIC, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2007
-----------------------------------------------------
Last Update Date | 11/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3722 7TH AVE
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-427-7122
-----------------------------------------------------
Fax | 763-427-4042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3722 7TH AVE
-----------------------------------------------------
City | ANOKA
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55303-1465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-427-7122
-----------------------------------------------------
Fax | 763-427-4042
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT OWNER
-----------------------------------------------------
Name | DR. KEITH M. BILLSTEIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 763-427-7122
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1983
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------