Provider Demographics
NPI:1891821799
Name:DRAKE CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:DRAKE CHIROPRACTIC, P.A.
Other - Org Name:VITAL INJURY CARE AND WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RUTZICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-287-0935
Mailing Address - Street 1:60 PLATO BLVD E
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1827
Mailing Address - Country:US
Mailing Address - Phone:651-287-0935
Mailing Address - Fax:651-287-0936
Practice Address - Street 1:60 PLATO BLVD E
Practice Address - Street 2:SUITE 110
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107-1827
Practice Address - Country:US
Practice Address - Phone:651-287-0935
Practice Address - Fax:651-287-0936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN524111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty