Organization
INNER LIGHT CHIROPRACTIC, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL S. DERHAK D.C. (PRESIDENT)
(612) 749-4600
Entity
Organization
Contact information
Practice address
4630 97TH AVE N, BROOKLYN PARK, MN 55443
(763) 486-3945
Mailing address
4630 97TH AVE N, BROOKLYN PARK, MN 55443
(763) 486-3945
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4717
MN
Other
Enumeration date
01/26/2006
Last updated
08/22/2020
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