Provider Demographics
NPI: | 1033455043 |
---|---|
Name: | THRIVE CHIROPRACTIC, PLLC |
Entity Type: | Organization |
Organization Name: | THRIVE CHIROPRACTIC, PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | LYNN |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | MILLER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 952-746-5612 |
Mailing Address - Street 1: | 14525 HIGHWAY 7 |
Mailing Address - Street 2: | STE 115 |
Mailing Address - City: | MINNETONKA |
Mailing Address - State: | MN |
Mailing Address - Zip Code: | 55345 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 952-746-5612 |
Mailing Address - Fax: | 952-229-4153 |
Practice Address - Street 1: | 14525 HIGHWAY 7 |
Practice Address - Street 2: | SUITE 115 |
Practice Address - City: | MINNETONKA |
Practice Address - State: | MN |
Practice Address - Zip Code: | 55345 |
Practice Address - Country: | US |
Practice Address - Phone: | 952-746-5612 |
Practice Address - Fax: | 952-229-4153 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-12-19 |
Last Update Date: | 2017-11-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | 4012 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |