Provider Demographics
NPI:1467682732
Name:TRILLIUM CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:TRILLIUM CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROD
Authorized Official - Middle Name:
Authorized Official - Last Name:OCHSENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-420-2226
Mailing Address - Street 1:13563 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4409
Mailing Address - Country:US
Mailing Address - Phone:763-420-2226
Mailing Address - Fax:763-420-5604
Practice Address - Street 1:13563 GROVE DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4409
Practice Address - Country:US
Practice Address - Phone:763-420-2226
Practice Address - Fax:763-420-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4768111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN77G43OCOtherBCBS 'AWARE' PROVIDER
MN77G43OCOtherBCBS 'AWARE' PROVIDER