Provider Demographics
NPI:1346886298
Name:STARTINGBLOCK CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:STARTINGBLOCK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:REISNOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-280-7720
Mailing Address - Street 1:3200 MAIN ST NW STE 330
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-8407
Mailing Address - Country:US
Mailing Address - Phone:763-280-7720
Mailing Address - Fax:763-280-7727
Practice Address - Street 1:3200 MAIN ST NW STE 330
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55448-8407
Practice Address - Country:US
Practice Address - Phone:763-280-7720
Practice Address - Fax:763-280-7727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1144741620Medicaid