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General NPI Number Information
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NPI Number | 1205117678
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Entity Type | Organization
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Legal Business Name | PREMIER HEALTH OF PLYMOUTH LTD
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Dates
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Enumeration Date | 08/30/2011
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 5801 DULUTH ST STE 345
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-3952
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Country | US
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Telephone | 763-354-7880
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Fax | 763-354-7882
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Provider Business Mailing Address
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Address Line | 5801 DULUTH ST STE 345
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City | GOLDEN VALLEY
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State | MN
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Zip | 55422-3952
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Country | US
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Telephone | 763-354-7880
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Fax | 763-354-7882
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN DAVID CHMIEL
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Credential | DC
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Telephone | 763-354-7880
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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 | 5191
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License Number State | MN
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