Provider Demographics
NPI:1275742900
Name:RIVERVIEW SPINE, P.A.
Entity Type:Organization
Organization Name:RIVERVIEW SPINE, P.A.
Other - Org Name:PREMIER HEALTH CHIROPRACTIC OF BLOOMINGTON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:OPFERKEW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-884-1507
Mailing Address - Street 1:5402 W. OLD SHAKOPEE ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437
Mailing Address - Country:US
Mailing Address - Phone:952-884-1507
Mailing Address - Fax:952-884-6744
Practice Address - Street 1:5402 W. OLD SHAKOPEE ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437
Practice Address - Country:US
Practice Address - Phone:952-884-1507
Practice Address - Fax:952-884-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MN4499111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04153Medicare ID - Type Unspecified