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General NPI Number Information
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NPI Number | 1518963768
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Entity Type | Organization
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Legal Business Name | NEW BRIGHTON CHIROPRACTIC CLINIC, P.A.
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 2216 COUNTY ROAD D W STE B
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-8505
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Country | US
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Telephone | 651-636-4120
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Fax | 651-630-1069
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Provider Business Mailing Address
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Address Line | 2216 COUNTY ROAD D W STE B
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City | SAINT PAUL
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State | MN
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Zip | 55112-8505
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Country | US
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Telephone | 651-636-4120
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Fax | 651-630-1069
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Authorized Official
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Title or Position | VP
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Name | DR. CHRISTIAN JON KOLLAR
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Credential | DC
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Telephone | 651-636-4120
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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 | 580
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License Number State | MN
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