Provider Demographics
NPI:1851839955
Name:TRILLIUM SPINAL CARE PLC
Entity Type:Organization
Organization Name:TRILLIUM SPINAL CARE PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALAN
Authorized Official - Middle Name:CLETE
Authorized Official - Last Name:STITTLEBURG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-937-0549
Mailing Address - Street 1:2300 SUPERIOR DR NW
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3061
Mailing Address - Country:US
Mailing Address - Phone:507-322-0133
Mailing Address - Fax:
Practice Address - Street 1:2300 SUPERIOR DR NW
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3061
Practice Address - Country:US
Practice Address - Phone:507-322-0133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6314111N00000X
MN6317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty