Provider Demographics
NPI:1962611608
Name:TOWN CENTER CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:TOWN CENTER CHIROPRACTIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-533-9997
Mailing Address - Street 1:4101 W BROADWAY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-1858
Mailing Address - Country:US
Mailing Address - Phone:763-533-9997
Mailing Address - Fax:763-533-6058
Practice Address - Street 1:4101 W BROADWAY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-1858
Practice Address - Country:US
Practice Address - Phone:763-533-9997
Practice Address - Fax:763-533-6058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04235Medicare ID - Type Unspecified
U88545Medicare UPIN