Provider Demographics
NPI:1003038241
Name:GARNETT CHIROPRACTIC & REHAB CENTER, PA
Entity Type:Organization
Organization Name:GARNETT CHIROPRACTIC & REHAB CENTER, PA
Other - Org Name:URBAN CHIRPRACTIC - ST PAUL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-225-4421
Mailing Address - Street 1:876 SELBY AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104
Mailing Address - Country:US
Mailing Address - Phone:651-225-4421
Mailing Address - Fax:651-222-4672
Practice Address - Street 1:876 SELBY AVE.
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-225-4421
Practice Address - Fax:651-222-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4384111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN658052OtherCHIROCARE
MN404L6GAOtherMN BLUE CROSS BLUE SHIELD
MN658052OtherCHIROCARE