Provider Demographics
NPI:1922248087
Name:EDEN CHRIOPRACTIC AND REHABILITATION, LLC
Entity Type:Organization
Organization Name:EDEN CHRIOPRACTIC AND REHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-360-5970
Mailing Address - Street 1:5200 WILLSON RD STE 308
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1344
Mailing Address - Country:US
Mailing Address - Phone:612-360-5970
Mailing Address - Fax:
Practice Address - Street 1:5200 WILLSON RD STE 308
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1344
Practice Address - Country:US
Practice Address - Phone:612-360-5970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty