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General NPI Number Information
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NPI Number | 1205370285
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Entity Type | Organization
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Legal Business Name | NORTHEAST CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 12/12/2016
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 34 13TH AVE NE STE 109
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1007
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Country | US
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Telephone | 612-378-1050
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Fax | 612-378-1051
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Provider Business Mailing Address
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Address Line | 34 13TH AVE NE STE 109
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City | MINNEAPOLIS
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State | MN
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Zip | 55413-1007
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Country | US
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Telephone | 612-378-1050
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Fax | 612-378-1051
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRAVIS MYRON SHERMER
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Credential | DC
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Telephone | 651-394-2280
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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 |
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License Number State |
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