MEDICARE: TONAL BALANCE CHIROPRACTIC AND NUTRITION, LLC

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	305S00000X	Point of Service	4643	MN

General Provider Information

NPI Number	:	1710117569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONAL BALANCE CHIROPRACTIC AND NUTRITION, LLC

Provider Business Mailing Address
First Line	:	2637 27TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-205-2513
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 27TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406-1565
Country	:	US
Telephone Number	:	612-205-2513
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEREMY BARTHELS
Credential	:	D.C.
Telephone Number	:	612-205-2513

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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