Provider Demographics
NPI:1174830293
Name:BRIDGE STREET CHIROPRACTIC, LTD.
Entity Type:Organization
Organization Name:BRIDGE STREET CHIROPRACTIC, LTD.
Other - Org Name:BRIDGES CHIROPRACTIC HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROEMHILDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-451-7580
Mailing Address - Street 1:215 18TH ST SE
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4003
Mailing Address - Country:US
Mailing Address - Phone:507-451-7580
Mailing Address - Fax:507-451-5387
Practice Address - Street 1:215 18TH ST SE
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4003
Practice Address - Country:US
Practice Address - Phone:507-451-7580
Practice Address - Fax:507-451-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN275723100Medicaid
MNC05701Medicare PIN