Provider Demographics
NPI:1336157973
Name:NORTHWEST CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:NORTHWEST CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUMENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-442-2437
Mailing Address - Street 1:2703 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1927
Mailing Address - Country:US
Mailing Address - Phone:612-442-2437
Mailing Address - Fax:612-367-4029
Practice Address - Street 1:2703 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1927
Practice Address - Country:US
Practice Address - Phone:612-442-2437
Practice Address - Fax:612-367-4029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty