Provider Demographics
NPI:1962640235
Name:TOTAL HEALTH CHIROPRACTIC AND SPORT, LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH CHIROPRACTIC AND SPORT, LLC
Other - Org Name:TOTAL HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MONTAG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-420-0254
Mailing Address - Street 1:12535 HILLSIDE LN SE
Mailing Address - Street 2:
Mailing Address - City:BECKER
Mailing Address - State:MN
Mailing Address - Zip Code:55308-8810
Mailing Address - Country:US
Mailing Address - Phone:320-420-0254
Mailing Address - Fax:
Practice Address - Street 1:12535 HILLSIDE LN SE
Practice Address - Street 2:
Practice Address - City:BECKER
Practice Address - State:MN
Practice Address - Zip Code:55308-8810
Practice Address - Country:US
Practice Address - Phone:320-420-0254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center