Provider Demographics
NPI:1922529528
Name:RESTORE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:RESTORE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRONTVET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-516-3090
Mailing Address - Street 1:15507 GROVE CIR N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4488
Mailing Address - Country:US
Mailing Address - Phone:612-516-3090
Mailing Address - Fax:
Practice Address - Street 1:15507 GROVE CIR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4488
Practice Address - Country:US
Practice Address - Phone:612-516-3090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6373111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty