MEDICARE: DR. ROBERT NEIL PRIVRATSKY JR. DC

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	DCP00528	RI
2	111N00000X	Chiropractor	DC-30794	CA
3	111N00000X	Chiropractor	6568	MN

General Provider Information

NPI Number	:	1639235161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT NEIL PRIVRATSKY JR. DC

Provider Business Mailing Address
First Line	:	1216 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2761
Country	:	US
Telephone Number	:	612-345-5376
Fax Number	:

Provider Business Practice Location Address
First Line	:	1216 W LAKE ST
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-2761
Country	:	US
Telephone Number	:	612-345-5376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	11/04/2019

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