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General NPI Number Information
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NPI Number | 1376835108
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Entity Type | Organization
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Legal Business Name | IN MOTION CHIROPRACTIC AND FITNESS CENTER
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 1161 WAYZATA BLVD E # 170
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City | WAYZATA
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State | MN
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Zip | 55391-1935
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Country | US
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Telephone | 763-694-1974
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Fax |
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Provider Business Mailing Address
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Address Line | 1161 WAYZATA BLVD E # 170
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City | WAYZATA
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State | MN
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Zip | 55391-1935
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN DEVITT
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Credential | D.C.
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Telephone | 763-694-1974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 3842
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License Number State | MN
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