Provider Demographics
NPI:1164626230
Name:PINNACLE CHIROPRACTIC AND ACUPUNCTURE, PA
Entity Type:Organization
Organization Name:PINNACLE CHIROPRACTIC AND ACUPUNCTURE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-544-3811
Mailing Address - Street 1:3021 HARBOR LN N
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5109
Mailing Address - Country:US
Mailing Address - Phone:763-544-3811
Mailing Address - Fax:763-544-9989
Practice Address - Street 1:3021 HARBOR LN N
Practice Address - Street 2:SUITE 109
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5109
Practice Address - Country:US
Practice Address - Phone:763-544-3811
Practice Address - Fax:763-544-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN104237OtherHEALTHPARTNERS ID
MN378L8KEOtherPROVIDER ID FOR BCBS
MN378L7PIOtherBCBS GROUP NUMBER
MNC03667Medicare ID - Type UnspecifiedPROVIDER ID MEDICARE