Provider Demographics
NPI:1275835589
Name:SPINAL MOTION CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SPINAL MOTION CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-210-9310
Mailing Address - Street 1:6550 YORK AVE S
Mailing Address - Street 2:SUITE 515
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2347
Mailing Address - Country:US
Mailing Address - Phone:651-230-5355
Mailing Address - Fax:952-926-8155
Practice Address - Street 1:6550 YORK AVE S
Practice Address - Street 2:SUITE 515
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2347
Practice Address - Country:US
Practice Address - Phone:651-230-5355
Practice Address - Fax:952-926-8155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5164111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty