Provider Demographics
NPI:1073688065
Name:OSSEO BACK AND NECK CLINIC, P.A.
Entity type:Organization
Organization Name:OSSEO BACK AND NECK CLINIC, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KELZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-425-5525
Mailing Address - Street 1:220 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OSSEO
Mailing Address - State:MN
Mailing Address - Zip Code:55369-1245
Mailing Address - Country:US
Mailing Address - Phone:763-425-5525
Mailing Address - Fax:763-425-6229
Practice Address - Street 1:220 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1245
Practice Address - Country:US
Practice Address - Phone:763-425-5525
Practice Address - Fax:763-425-6229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3440111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN604271OtherHEALTH PARTNERS
MN02D86OSOtherBCBS
MN44-40379OtherMEDICA
MN604271OtherHEALTH PARTNERS