MEDICARE: TWIN CITIES HEADACHE & NECK, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3759	MN

General Provider Information

NPI Number	:	1043457997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN CITIES HEADACHE & NECK, LTD.

Provider Business Mailing Address
First Line	:	261 RUTH ST N
Second Line	:	SUITE 115
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4337
Country	:	US
Telephone Number	:	651-925-5530
Fax Number	:	651-739-8452

Provider Business Practice Location Address
First Line	:	261 RUTH ST N
Second Line	:	SUITE 115
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4337
Country	:	US
Telephone Number	:	651-925-5530
Fax Number	:	651-739-8452

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATTHEW COLLINS
Credential	:	D.C.
Telephone Number	:	651-925-5530

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	01/14/2009

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