Provider Demographics
NPI:1467233478
Name:RESTORATION CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:RESTORATION CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:COVELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-990-1097
Mailing Address - Street 1:1282 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2296
Mailing Address - Country:US
Mailing Address - Phone:507-990-1097
Mailing Address - Fax:
Practice Address - Street 1:2103 COUNTY ROAD D E UNIT A
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-5357
Practice Address - Country:US
Practice Address - Phone:612-295-0180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty