Provider Demographics
NPI:1609014620
Name:TWIN CITIES MECHANICAL DIAGNOSIS AND TREATMENT GROUP PA
Entity Type:Organization
Organization Name:TWIN CITIES MECHANICAL DIAGNOSIS AND TREATMENT GROUP PA
Other - Org Name:ST CROIX CHIROPRACTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-735-1580
Mailing Address - Street 1:600 INWOOD AVE N STE 240
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-7148
Mailing Address - Country:US
Mailing Address - Phone:651-735-1580
Mailing Address - Fax:651-735-0545
Practice Address - Street 1:600 INWOOD AVE N STE 240
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-7148
Practice Address - Country:US
Practice Address - Phone:651-735-1580
Practice Address - Fax:651-735-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN513111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty