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General NPI Number Information
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NPI Number | 1427290303
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Entity Type | Organization
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Legal Business Name | PINE RIDGE CHIROPRACTIC
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Dates
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Enumeration Date | 03/24/2009
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 26273 2ND ST E
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City | ZIMMERMAN
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State | MN
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Zip | 55398-4672
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Country | US
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Telephone | 763-856-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 26273 2ND ST E
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City | ZIMMERMAN
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State | MN
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Zip | 55398-4672
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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 | CHIROPRACTOR/OWNER
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Name | DR. STEVEN R LUGINBILL
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Credential | D.C.
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Telephone | 763-856-9588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1925
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License Number State | MN
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