Provider Demographics
NPI:1992803548
Name:ROBINSON, BRENT JAMES CHARLES (DC)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:JAMES CHARLES
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 LEXINGTON AVE N
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6514
Mailing Address - Country:US
Mailing Address - Phone:651-779-5998
Mailing Address - Fax:651-789-0809
Practice Address - Street 1:1752 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6516
Practice Address - Country:US
Practice Address - Phone:651-487-5950
Practice Address - Fax:651-487-6016
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor