Provider Demographics
NPI:1013355478
Name:WAYPOINT MINNESOTA SPORTS PC
Entity Type:Organization
Organization Name:WAYPOINT MINNESOTA SPORTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER / SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-434-9669
Mailing Address - Street 1:9325 UPLAND LN N
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4200
Mailing Address - Country:US
Mailing Address - Phone:763-315-0466
Mailing Address - Fax:
Practice Address - Street 1:9325 UPLAND LN N
Practice Address - Street 2:SUITE 230
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4200
Practice Address - Country:US
Practice Address - Phone:763-315-0466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty