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Organization
INSTITUTE FOR CHIROPRACTIC REHABILITATION PA
Active
Organization
INSTITUTE FOR CHIROPRACTIC REHABILITATION PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON MICHAEL FREDERICKS DC (PRESIDENT)
(952) 884-6144
Entity
Organization
Contact information
Practice address
8200 HUMBOLDT AVE S STE 204, BLOOMINGTON, MN 55431-1432
(952) 884-6144
(952) 884-9180
Mailing address
8200 HUMBOLDT AVE S STE 204, BLOOMINGTON, MN 55431-1432
(952) 884-6144
(952) 884-9180
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Enumeration date
04/24/2009
Last updated
04/24/2009
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