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Organization
DEEPHAVEN CHIROPRACTIC, P.A.
Active
Organization
DEEPHAVEN CHIROPRACTIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAMMY JO LOVE D.C. (CEO)
(952) 475-0079
Entity
Organization
Contact information
Practice address
18281 MINNETONKA BLVD, WAYZATA, MN 55391-3345
(952) 475-0079
(952) 475-1030
Mailing address
18281 MINNETONKA BLVD, WAYZATA, MN 55391-3345
(952) 475-0079
(952) 475-1030
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3658
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60B90DE
BCBS
MN
01
—
U82339
METROPOLITAN HEALTH PLAN
MN
Enumeration date
09/20/2006
Last updated
01/14/2010
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