Provider Demographics
NPI:1447806260
Name:PRIVRATSKY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:PRIVRATSKY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:PRIVRATSKY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:415-794-3081
Mailing Address - Street 1:1216 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-2761
Mailing Address - Country:US
Mailing Address - Phone:612-345-5376
Mailing Address - Fax:
Practice Address - Street 1:1216 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-2761
Practice Address - Country:US
Practice Address - Phone:612-345-5376
Practice Address - Fax:612-345-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty