Provider Demographics
NPI:1821657545
Name:BIG BRAIN CONCUSSION RECOVERY & CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BIG BRAIN CONCUSSION RECOVERY & CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:STUSSY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-374-3392
Mailing Address - Street 1:3313 REPUBLIC AVE.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:612-374-3392
Mailing Address - Fax:612-374-3477
Practice Address - Street 1:3313 REPUBLIC AVE.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426
Practice Address - Country:US
Practice Address - Phone:612-374-3392
Practice Address - Fax:612-374-3477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty