Provider Demographics
NPI:1750823431
Name:TOTAL BODY CHIROPRACTIC CARE LLC
Entity Type:Organization
Organization Name:TOTAL BODY CHIROPRACTIC CARE LLC
Other - Org Name:TOTAL BODY CHIROPRACTIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-892-1628
Mailing Address - Street 1:14300 BUCK HILL RD STE E
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-6245
Mailing Address - Country:US
Mailing Address - Phone:952-892-1628
Mailing Address - Fax:
Practice Address - Street 1:14300 BUCK HILL RD STE E
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-6245
Practice Address - Country:US
Practice Address - Phone:952-892-1628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty