Provider Demographics
NPI:1215058102
Name:DISCOVER CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:DISCOVER CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-224-9501
Mailing Address - Street 1:101 W BURNSVILLE PKWY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2571
Mailing Address - Country:US
Mailing Address - Phone:952-224-9501
Mailing Address - Fax:952-224-9503
Practice Address - Street 1:101 W BURNSVILLE PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2571
Practice Address - Country:US
Practice Address - Phone:952-224-9501
Practice Address - Fax:952-224-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5691427-00Medicaid
MN7815204-00Medicaid
MN64B04OBOtherBCBS - OFFICE PROVIDER #
MN64B05OBOtherDR. O'BRIEN'S BCBS #
MN4572921-00Medicaid
MN64B04OBOtherBCBS - OFFICE PROVIDER #
MN4572921-00Medicaid