MEDICARE: ACCESS CHIROPRACTIC CLINIC

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	111NR0400X	Rehabilitation Chiropractor	4511	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	373K4AC	OTHER	MN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1548408081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS CHIROPRACTIC CLINIC

Provider Business Mailing Address
First Line	:	1113 E FRANKLIN AVE
Second Line	:	SUITE 101
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2974
Country	:	US
Telephone Number	:	612-879-9388
Fax Number	:	612-879-0005

Provider Business Practice Location Address
First Line	:	1113 E FRANKLIN AVE
Second Line	:	SUITE 101
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-2974
Country	:	US
Telephone Number	:	612-879-9388
Fax Number	:	612-879-0005

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. RASHID ALI HASSEN
Credential	:	D.C.
Telephone Number	:	612-879-9388

Provider Enumeration Date	:	01/21/2009
Last Update Date	:	02/11/2009

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1659502086 — DR. AYMEN HASSEN D.C.
Practice Location Address:

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Directions to “ACCESS CHIROPRACTIC CLINIC ” Practice Location

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