Provider Demographics
NPI:1700499308
Name:DEVRIES SPINE CARE PLLC
Entity type:Organization
Organization Name:DEVRIES SPINE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYNE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-200-6152
Mailing Address - Street 1:3606 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-1366
Mailing Address - Country:US
Mailing Address - Phone:952-200-6152
Mailing Address - Fax:
Practice Address - Street 1:4748 CHICAGO AVE STE 10
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4311
Practice Address - Country:US
Practice Address - Phone:612-492-1961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty