MEDICARE: TWIN CITIES SPINE & SPORTS, PLLC

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	2251S0007X	Sports Physical Therapist
2	111NS0005X	Sports Physician Chiropractor

General Provider Information

NPI Number	:	1144492083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWIN CITIES SPINE & SPORTS, PLLC

Provider Business Mailing Address
First Line	:	6409 CITY WEST PKWY
Second Line	:	SUITE 100
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7845
Country	:	US
Telephone Number	:	952-941-3311
Fax Number	:	952-944-2004

Provider Business Practice Location Address
First Line	:	6409 CITY WEST PKWY
Second Line	:	SUITE 100
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7845
Country	:	US
Telephone Number	:	952-941-3311
Fax Number	:	952-944-2004

Authorized Official
Title or Position	:	CHIROPRACTOR, PHYSICAL THERAPIST
Name	:	DR. RICHARD A HILLS
Credential	:
Telephone Number	:	952-941-3311

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	04/01/2008

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