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General NPI Number Information
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NPI Number | 1316281637
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Entity Type | Organization
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Legal Business Name | EVOLUTION CHIROPRACTIC, P.A.
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 8120 PENN AVE S SUITE 444
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1358
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Country | US
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Telephone | 952-270-5374
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Fax | 952-223-6153
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Provider Business Mailing Address
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Address Line | 8120 PENN AVE S SUITE 444
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City | BLOOMINGTON
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State | MN
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Zip | 55431-1358
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Country | US
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Telephone | 952-270-5374
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Fax | 952-223-6153
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. JODI MARIE DORPINGHAUS
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Credential | D.C.
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Telephone | 952-564-6452
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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 | 5117
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License Number State | MN
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