Provider Demographics
NPI:1881924710
Name:MOUKRIM, MALIKA BAANI (DC)
Entity type:Individual
Prefix:
First Name:MALIKA
Middle Name:BAANI
Last Name:MOUKRIM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14214 DAVENPORT PATH
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4177
Mailing Address - Country:US
Mailing Address - Phone:952-649-2109
Mailing Address - Fax:
Practice Address - Street 1:1845 STINSON BLVD
Practice Address - Street 2:STE 202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-4897
Practice Address - Country:US
Practice Address - Phone:651-699-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-25
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5296111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor