Provider Demographics
NPI:1710698477
Name:DYNAMIC CHIROPRACTIC AND REHAB PLLC
Entity Type:Organization
Organization Name:DYNAMIC CHIROPRACTIC AND REHAB PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-297-1010
Mailing Address - Street 1:2206 BLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LESTER PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55354-4506
Mailing Address - Country:US
Mailing Address - Phone:612-709-9700
Mailing Address - Fax:
Practice Address - Street 1:2204 COMMERCE BLVD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-1547
Practice Address - Country:US
Practice Address - Phone:952-297-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DYNAMIC CHIROPRACTIC AND REHAB PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty