Provider Demographics
NPI:1992002661
Name:SUNU CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:SUNU CHIROPRACTIC, INC.
Other - Org Name:BACK TO BALANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ARMIITA
Authorized Official - Last Name:TOUSIGNANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-545-3839
Mailing Address - Street 1:13911 RIDGEDALE DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1771
Mailing Address - Country:US
Mailing Address - Phone:952-545-3839
Mailing Address - Fax:952-546-0168
Practice Address - Street 1:13911 RIDGEDALE DR
Practice Address - Street 2:SUITE 255
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1771
Practice Address - Country:US
Practice Address - Phone:952-545-3839
Practice Address - Fax:952-546-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5268111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004443Medicare PIN