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Organization
CHIROPRACTIC ADVANTAGE, LLC
Active
Organization
CHIROPRACTIC ADVANTAGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN S ELIJAH (OWNER PRESIDENT)
(952) 884-3700
Entity
Organization
Contact information
Practice address
8900 PENN AVE S, SUITE 116, BLOOMINGTON, MN 55431-2068
(952) 884-3700
(612) 656-0550
Mailing address
8900 PENN AVE S, 116, BLOOMINGTON, MN 55431-2068
(952) 884-3700
(612) 656-0550
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3278
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00B97EL
BCBS PROVIDER ID
MN
01
—
1B00B6CH
BCBS CLINIC ID
MN
01
—
4485431
MEDICA PROVIDER ID
MN
Enumeration date
06/05/2007
Last updated
06/09/2008
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