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General NPI Number Information
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NPI Number | 1396966057
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Entity Type | Organization
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Legal Business Name | MINNESOTA DISC INSTITUTE, PA
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/11/2018
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Provider Practice Location Address
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Address Line | 7300 FRANCE AVE S STE 350
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-500-8090
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Fax | 952-500-8192
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Provider Business Mailing Address
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Address Line | 7300 FRANCE AVE S STE 350
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City | EDINA
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State | MN
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Zip | 55435-4505
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Country | US
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Telephone | 952-500-8090
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Fax | 952-500-8192
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Authorized Official
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Title or Position | CEO
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Name | DR. JAMY CHRISTOPHER ANTOINE
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Credential | DC
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Telephone | 952-567-2379
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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 | 4332
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License Number State | MN
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