Provider Demographics
NPI:1396221966
Name:NORTHERN HOPE FUNCTIONAL NEUROLOGY AND CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTHERN HOPE FUNCTIONAL NEUROLOGY AND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-670-2898
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-0505
Mailing Address - Country:US
Mailing Address - Phone:605-670-2898
Mailing Address - Fax:
Practice Address - Street 1:25503 MAIN ST
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-5000
Practice Address - Country:US
Practice Address - Phone:605-670-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4970111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty