Provider Demographics
NPI:1396074209
Name:TWIN CITIES MOBILE CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:TWIN CITIES MOBILE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-983-8954
Mailing Address - Street 1:PO BOX 262
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-0262
Mailing Address - Country:US
Mailing Address - Phone:651-983-8954
Mailing Address - Fax:
Practice Address - Street 1:6754 380TH CIRCLE
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056
Practice Address - Country:US
Practice Address - Phone:651-983-8954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3643261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care