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NPI Code Detail

MEDICARE: DYNAMIC FAMILY CHIROPRACTIC PA

MEDICARE: DYNAMIC FAMILY CHIROPRACTIC PA
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
1111NR0400XRehabilitation Chiropractor4012MN
2111N00000XChiropractor3475MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
16C437LUOTHERMNBLUE CROSS BLUE SHIELD
2325J4MIOTHERMNBLUE CROSS BLUE SHIELD
36C438LUOTHERMNBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1427186907
Entity Type Code : Organization
Provider Name (Legal Business Name) : DYNAMIC FAMILY CHIROPRACTIC PA
Provider Business Mailing Address
First Line : 4739 COUNTY ROAD 101
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-2634
Country : US
Telephone Number : 952-933-2695
Fax Number : 952-933-2763
Provider Business Practice Location Address
First Line : 4739 COUNTY ROAD 101
Second Line :
City : MINNETONKA
State : MN
Zip : 55345-2634
Country : US
Telephone Number : 952-933-2695
Fax Number : 952-933-2763
Authorized Official
Title or Position : OWNER
Name : MR. ANDREW E. LUING
Credential :
Telephone Number : 952-933-2695
Provider Enumeration Date : 02/28/2007
Last Update Date : 03/04/2008

Similar Medicare Providers

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1396818613 — RANDALL S. VOLLERTSEN MD. INC
Practice Location Address:
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Practice Fax: 952-974-3201

Directions to “DYNAMIC FAMILY CHIROPRACTIC PA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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