Provider Demographics
NPI:1972774073
Name:HEALTHSOURCE OF BURNSVILLE, P.A.
Entity type:Organization
Organization Name:HEALTHSOURCE OF BURNSVILLE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEHNKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-707-0110
Mailing Address - Street 1:200 E TRAVELERS TRL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4097
Mailing Address - Country:US
Mailing Address - Phone:952-707-0110
Mailing Address - Fax:952-707-0115
Practice Address - Street 1:200 E TRAVELERS TRL
Practice Address - Street 2:SUITE 105
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4097
Practice Address - Country:US
Practice Address - Phone:952-707-0110
Practice Address - Fax:952-707-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5044261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04928Medicare PIN