MEDICARE: MCBRIDE 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
1	111N00000X	Chiropractor	002981	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00067312	OTHER	MN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3C527MC	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457491862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCBRIDE CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	1751 SE 2ND AVE
Second Line	:
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2586
Country	:	US
Telephone Number	:	218-326-2828
Fax Number	:	218-326-2516

Provider Business Practice Location Address
First Line	:	1751 SE 2ND AVE
Second Line	:	SUITE 3
City	:	GRAND RAPIDS
State	:	MN
Zip	:	55744-2586
Country	:	US
Telephone Number	:	218-326-2828
Fax Number	:	218-326-2516

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD SCOTT MCBRIDE JR.
Credential	:	D.C.
Telephone Number	:	218-326-2828

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	12/04/2017

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Directions to “MCBRIDE CHIROPRACTIC PA ” Practice Location

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