Provider Demographics
NPI:1679649818
Name:TORGRIMSON, ROBERT JAMES (DC DABCO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAMES
Last Name:TORGRIMSON
Suffix:
Gender:M
Credentials:DC DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 KENWOOD AVENUE
Mailing Address - Street 2:ASSOCIATED CHIROPRACTIC PHYSICIANS
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-728-3686
Mailing Address - Fax:218-728-2996
Practice Address - Street 1:1320 KENWOOD AVENUE
Practice Address - Street 2:ASSOCIATED CHIROPRACTIC PHYSICIANS
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-728-3686
Practice Address - Fax:218-728-2996
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1579111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN03039T0OtherBCBS
MN930527100Medicaid
MN03039T0OtherBCBS
MNC06160Medicare ID - Type Unspecified