Provider Demographics
NPI:1275992141
Name:MOBILE CHIROPRACTIC & REHAB, PC
Entity Type:Organization
Organization Name:MOBILE CHIROPRACTIC & REHAB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-898-1919
Mailing Address - Street 1:745 CRYSTAL LAKE RD E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5174
Mailing Address - Country:US
Mailing Address - Phone:952-898-1919
Mailing Address - Fax:
Practice Address - Street 1:745 CRYSTAL LAKE RD E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5174
Practice Address - Country:US
Practice Address - Phone:952-898-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN480261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center