Provider Demographics
NPI:1508018490
Name:COMPREHENSIVE REHAB CENTERS OF MN
Entity Type:Organization
Organization Name:COMPREHENSIVE REHAB CENTERS OF MN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ATHLETIC TRAINER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTHUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:612-823-2020
Mailing Address - Street 1:133 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3119
Practice Address - Country:US
Practice Address - Phone:612-823-2020
Practice Address - Fax:612-823-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4690111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty