Provider Demographics
NPI:1972926707
Name:MINNESOTA SPINE AND PAIN INSTITUTE, PA
Entity Type:Organization
Organization Name:MINNESOTA SPINE AND PAIN INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:F
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-331-1460
Mailing Address - Street 1:5174 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421
Mailing Address - Country:US
Mailing Address - Phone:651-331-1460
Mailing Address - Fax:
Practice Address - Street 1:5174 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421
Practice Address - Country:US
Practice Address - Phone:651-331-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5444111N00000X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty