Provider Demographics
NPI:1346567609
Name:HEALTHQUEST SPORTS INJURY AND CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:HEALTHQUEST SPORTS INJURY AND CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:NORTHRUP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-292-9247
Mailing Address - Street 1:1053 GRAND AVE
Mailing Address - Street 2:114
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3022
Mailing Address - Country:US
Mailing Address - Phone:656-292-9247
Mailing Address - Fax:651-292-9257
Practice Address - Street 1:1053 GRAND AVE
Practice Address - Street 2:114
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-3022
Practice Address - Country:US
Practice Address - Phone:656-292-9247
Practice Address - Fax:651-292-9257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5324302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization