Provider Demographics
NPI:1063013340
Name:PLYMOUTH CHIROCENTER LLC
Entity Type:Organization
Organization Name:PLYMOUTH CHIROCENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ALLENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-212-7489
Mailing Address - Street 1:3900 VINEWOOD LN N STE 19
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1155
Mailing Address - Country:US
Mailing Address - Phone:763-559-9236
Mailing Address - Fax:763-559-4856
Practice Address - Street 1:3900 VINEWOOD LN N STE 19
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1155
Practice Address - Country:US
Practice Address - Phone:763-559-9236
Practice Address - Fax:763-559-4856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty