MEDICARE: EDEN PRAIRIE CHIROPRACTIC CLINIC INC

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

General Provider Information

NPI Number	:	1043929813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDEN PRAIRIE CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	7820 TERREY PINE CT STE 102
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1107
Country	:	US
Telephone Number	:	952-937-1226
Fax Number	:

Provider Business Practice Location Address
First Line	:	7820 TERREY PINE CT STE 102
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55347-1107
Country	:	US
Telephone Number	:	952-937-1226
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN THOMAS ALLENBURG
Credential	:	DC
Telephone Number	:	952-212-7489

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	01/27/2023

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