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General NPI Number Information
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NPI Number | 1992021851
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Entity Type | Organization
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Legal Business Name | PDR CHANHASSEN, LTD
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 18912 LAKE DR E
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City | CHANHASSEN
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State | MN
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Zip | 55317-9348
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Country | US
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Telephone | 952-908-2730
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Fax | 952-908-2731
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Provider Business Mailing Address
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Address Line | 18912 LAKE DR E
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City | CHANHASSEN
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State | MN
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Zip | 55317-9348
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Country | US
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Telephone | 952-908-2730
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Fax | 952-908-2731
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Authorized Official
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Title or Position | OWNER
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Name | TODD GINKEL
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Credential | DC
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Telephone | 952-908-2565
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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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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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