Provider Demographics
NPI:1033500657
Name:THREE PHASES PA
Entity Type:Organization
Organization Name:THREE PHASES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-336-5862
Mailing Address - Street 1:2323 94TH WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1183
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 E LAKE ST
Practice Address - Street 2:SUTIE 3350
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1963
Practice Address - Country:US
Practice Address - Phone:612-721-7771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4538111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty