MEDICARE: ODA CHIROPRACTIC HEALTH CENTER

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	4984	MN

General Provider Information

NPI Number	:	1316139009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ODA CHIROPRACTIC HEALTH CENTER

Provider Business Mailing Address
First Line	:	2800 UNIVERSITY AVE SE STE 200
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-4204
Country	:	US
Telephone Number	:	612-331-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 UNIVERSITY AVE SE STE 200
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-4204
Country	:	US
Telephone Number	:	612-331-6800
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF CHIROPRACTIC
Name	:	DR. HAMZA BUSHRA ADEM
Credential	:
Telephone Number	:	612-331-6800

Provider Enumeration Date	:	08/15/2007
Last Update Date	:	08/15/2007

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