| Back In Shape Chiropractic | |
|
669 Winnetka Ave N Suite 202 Golden Valley MN 55427-4574 | |
| (763) 595-9096 | |
| (763) 595-0291 |
| Full Name | Back In Shape Chiropractic |
|---|---|
| Speciality | Clinic/Center |
| Location | 669 Winnetka Ave N, Golden Valley, Minnesota |
| Authorized Official Name and Position | Dianne L. Como (OWNER/PRESIDENT/CHIROPRACTOR) |
| Authorized Official Contact | 7635959096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Back In Shape Chiropractic 669 Winnetka Ave N Suite 202 Golden Valley MN 55427-4574 Ph: (763) 595-9096 | Back In Shape Chiropractic 669 Winnetka Ave N Suite 202 Golden Valley MN 55427-4574 Ph: (763) 595-9096 |
| NPI Number | 1205933306 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 08/19/2008 |
| Medicare PECOS PAC ID | 8022063130 |
|---|---|
| Medicare Enrollment ID | O20050322000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205933306 | NPI | - | NPPES |
| 55F12CO | Other | MN | BCBS |
| 889027700 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 3191 (Minnesota) | Primary |
| Provider Name | Dianne L Como |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1689672982 PECOS PAC ID: 7012962129 Enrollment ID: I20050323000021 |
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