Provider Demographics
NPI:1932237187
Name:SPINAL REHAB CLINICS, PA
Entity type:Organization
Organization Name:SPINAL REHAB CLINICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-252-2225
Mailing Address - Street 1:225 N BENTON DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1574
Mailing Address - Country:US
Mailing Address - Phone:320-252-2225
Mailing Address - Fax:320-252-2159
Practice Address - Street 1:225 N BENTON DR STE 105
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1574
Practice Address - Country:US
Practice Address - Phone:320-252-2225
Practice Address - Fax:320-252-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCS4516OtherRAILROAD MEDICARE
MN799325100Medicaid
MN55040MCOtherBLUE CROSS BLUE SHIELD
MN799325100Medicaid