Provider Demographics
NPI:1912108911
Name:NORTH METRO CHIROPRACTIC CLINIC P.A.
Entity Type:Organization
Organization Name:NORTH METRO CHIROPRACTIC CLINIC P.A.
Other - Org Name:RUM RIVER CHIROPRACTIC CLINIC P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-689-0462
Mailing Address - Street 1:1525 HIGHWAY 95 E
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1756
Mailing Address - Country:US
Mailing Address - Phone:763-689-0462
Mailing Address - Fax:763-689-6995
Practice Address - Street 1:1525 HIGHWAY 95 E
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1756
Practice Address - Country:US
Practice Address - Phone:763-689-0462
Practice Address - Fax:763-689-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN466OtherSTATE CHIRO FIRM NUMBER
MN17F26RUOtherBCBS GROUP NUMBER
MNC03257Medicare ID - Type Unspecified