Provider Demographics
NPI:1033243167
Name:LORDEX SPINE INSTITUTE OF MINNEAPOLIS, LLC
Entity Type:Organization
Organization Name:LORDEX SPINE INSTITUTE OF MINNEAPOLIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-926-7246
Mailing Address - Street 1:2900 THOMAS AVE S
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4477
Mailing Address - Country:US
Mailing Address - Phone:612-926-7246
Mailing Address - Fax:612-915-1439
Practice Address - Street 1:2900 THOMAS AVE S
Practice Address - Street 2:SUITE 330
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-4477
Practice Address - Country:US
Practice Address - Phone:612-926-7246
Practice Address - Fax:612-915-1439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04041Medicare ID - Type UnspecifiedMEDICARE PROVIDER #