Provider Demographics
NPI:1831284447
Name:RAND, PHILLIP C (DC)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:C
Last Name:RAND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:C
Other - Last Name:RAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:6200 EXCELSIOR BLVD
Mailing Address - Street 2:STE204
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2734
Mailing Address - Country:US
Mailing Address - Phone:952-925-4639
Mailing Address - Fax:952-925-2404
Practice Address - Street 1:6200 EXCELSIOR BLVD
Practice Address - Street 2:STE204
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2734
Practice Address - Country:US
Practice Address - Phone:952-925-4639
Practice Address - Fax:952-925-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU96828Medicare UPIN