Provider Demographics
NPI:1427186907
Name:DYNAMIC FAMILY CHIROPRACTIC PA
Entity Type:Organization
Organization Name:DYNAMIC FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-933-2695
Mailing Address - Street 1:4739 COUNTY ROAD 101
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-2634
Mailing Address - Country:US
Mailing Address - Phone:952-933-2695
Mailing Address - Fax:952-933-2763
Practice Address - Street 1:4739 COUNTY ROAD 101
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-2634
Practice Address - Country:US
Practice Address - Phone:952-933-2695
Practice Address - Fax:952-933-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3475111N00000X
MN4012111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6C437LUOtherBLUE CROSS BLUE SHIELD
MN325J4MIOtherBLUE CROSS BLUE SHIELD
MN6C438LUOtherBLUE CROSS BLUE SHIELD