Provider Demographics
NPI:1316535958
Name:PRIME CHIROPRACTIC & REHAB CENTER
Entity Type:Organization
Organization Name:PRIME CHIROPRACTIC & REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/D.C.
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:JH
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-235-9736
Mailing Address - Street 1:200 VILLAGE CENTER DR STE 800
Mailing Address - Street 2:
Mailing Address - City:NORTH OAKS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7092
Mailing Address - Country:US
Mailing Address - Phone:651-235-9736
Mailing Address - Fax:651-800-9895
Practice Address - Street 1:200 VILLAGE CENTER DR STE 800
Practice Address - Street 2:
Practice Address - City:NORTH OAKS
Practice Address - State:MN
Practice Address - Zip Code:55127-7092
Practice Address - Country:US
Practice Address - Phone:651-235-9736
Practice Address - Fax:651-800-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty