Provider Demographics
NPI:1356607238
Name:CHIROPRACTIC CONCEPTS LLC
Entity type:Organization
Organization Name:CHIROPRACTIC CONCEPTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR /CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ELLWANGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-405-6853
Mailing Address - Street 1:3311 COUNTY ROAD 101 S STE 2
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2879
Mailing Address - Country:US
Mailing Address - Phone:952-405-6853
Mailing Address - Fax:952-406-8060
Practice Address - Street 1:3311 COUNTY ROAD 101 S STE 2
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2879
Practice Address - Country:US
Practice Address - Phone:952-405-6853
Practice Address - Fax:952-406-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5310111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty