MEDICARE: SOLI 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	3786	MN

General Provider Information

NPI Number	:	1669781753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLI CHIROPRACTIC, PA

Provider Business Mailing Address
First Line	:	7240 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55429-1274
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7240 BROOKLYN BLVD
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55429-1274
Country	:	US
Telephone Number	:	763-560-0750
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK SOLI
Credential	:
Telephone Number	:	763-560-0750

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	10/07/2010

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