Provider Demographics
NPI:1457568768
Name:URBAN CHIROPRACTIC
Entity Type:Organization
Organization Name:URBAN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-288-3098
Mailing Address - Street 1:2353 RICE ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-3739
Mailing Address - Country:US
Mailing Address - Phone:651-288-3098
Mailing Address - Fax:651-288-3078
Practice Address - Street 1:2353 RICE ST
Practice Address - Street 2:SUITE 225
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3739
Practice Address - Country:US
Practice Address - Phone:651-288-3098
Practice Address - Fax:651-288-3078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty