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General NPI Number Information
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NPI Number | 1972264083
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Entity Type | Organization
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Legal Business Name | CHIROSTRENGTH TWIN CITIES LLC
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Dates
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Enumeration Date | 01/02/2022
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Last Update Date | 01/02/2022
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Provider Practice Location Address
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Address Line | 11311 DAYTON RIVER RD
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City | DAYTON
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State | MN
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Zip | 55327-7500
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Country | US
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Telephone | 612-314-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 474 ARROWHEAD DR
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City | LINO LAKES
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State | MN
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Zip | 55014-1402
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Country | US
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Telephone | 320-309-3388
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BLAKE CHRISTOPHER LOXTERCAMP
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Credential | DC, MS, CSCS
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Telephone | 320-309-3388
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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 |
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License Number State |
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