Provider Demographics
NPI:1396966057
Name:MINNESOTA DISC INSTITUTE, PA
Entity type:Organization
Organization Name:MINNESOTA DISC INSTITUTE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMY
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:ANTOINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-567-2379
Mailing Address - Street 1:7300 FRANCE AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4505
Mailing Address - Country:US
Mailing Address - Phone:952-500-8090
Mailing Address - Fax:952-500-8192
Practice Address - Street 1:7300 FRANCE AVE S STE 350
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-500-8090
Practice Address - Fax:952-500-8192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU97309Medicare UPIN
MN350003121Medicare ID - Type Unspecified