Provider Demographics
NPI:1366501736
Name:TWIN CITIES CHIROPRACTIC AND REHABILITATION
Entity Type:Organization
Organization Name:TWIN CITIES CHIROPRACTIC AND REHABILITATION
Other - Org Name:TWIN CITIES SPINE CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-224-1921
Mailing Address - Street 1:506 LEXINGTON PKWY N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4644
Mailing Address - Country:US
Mailing Address - Phone:651-224-1921
Mailing Address - Fax:651-224-1936
Practice Address - Street 1:506 LEXINGTON PKWY N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4644
Practice Address - Country:US
Practice Address - Phone:651-224-1921
Practice Address - Fax:651-224-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3639111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0058858Medicaid