Provider Demographics
NPI:1992971949
Name:COMPREHENSIVE REHABILITATION CENTERS OF MINNESOTA
Entity type:Organization
Organization Name:COMPREHENSIVE REHABILITATION CENTERS OF MINNESOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-888-4288
Mailing Address - Street 1:133 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3119
Mailing Address - Country:US
Mailing Address - Phone:612-823-2020
Mailing Address - Fax:612-823-1919
Practice Address - Street 1:133 W LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3119
Practice Address - Country:US
Practice Address - Phone:612-823-2020
Practice Address - Fax:612-823-1919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty