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General NPI Number Information
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NPI Number | 1265768220
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Entity Type | Organization
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Legal Business Name | BACK 2 HEALTH CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 10/27/2009
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Last Update Date | 10/27/2009
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Provider Practice Location Address
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Address Line | 1125 SOUTH CEDAR ST SUITE 109
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City | MONTICELLO
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State | MN
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Zip | 55362
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Country | US
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Telephone | 612-578-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 23575 ASPEN DR
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City | ROGERS
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State | MN
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Zip | 55374-8781
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Country | US
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Telephone | 612-578-3151
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY KENNETH KLEIN
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Credential | D.C.
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Telephone | 612-578-3151
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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 | 4184
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License Number State | MN
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