MEDICARE: BROOKLYN CENTER SPORTS & INJURY

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	6099	MN

General Provider Information

NPI Number	:	1780055632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN CENTER SPORTS & INJURY

Provider Business Mailing Address
First Line	:	PO BOX 9287
Second Line	:
City	:	RIVIERA BEACH
State	:	FL
Zip	:	33419-9287
Country	:	US
Telephone Number	:	561-881-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 SHINGLE CREEK PKWY
Second Line	:	SUITE 110
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55430-2124
Country	:	US
Telephone Number	:	612-444-3308
Fax Number	:	612-444-3309

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT KLEINFELD
Credential	:	DC
Telephone Number	:	561-881-3003

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	10/16/2015

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