Provider Demographics
NPI:1851115125
Name:MILLENNIUM CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:MILLENNIUM CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-738-1662
Mailing Address - Street 1:2722 PARK AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1009
Mailing Address - Country:US
Mailing Address - Phone:952-944-5516
Mailing Address - Fax:612-605-0122
Practice Address - Street 1:2722 PARK AVE STE 1
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1009
Practice Address - Country:US
Practice Address - Phone:952-944-5516
Practice Address - Fax:612-605-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty