Provider Demographics
NPI:1598210015
Name:MOTION LAB CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:MOTION LAB CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MORTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-963-7844
Mailing Address - Street 1:4444 W 76TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5173
Mailing Address - Country:US
Mailing Address - Phone:612-963-7844
Mailing Address - Fax:
Practice Address - Street 1:4444 W 76TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5173
Practice Address - Country:US
Practice Address - Phone:612-963-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty