Provider Demographics
NPI:1003067802
Name:ACQUA CHIROPRACTIC SPA
Entity type:Organization
Organization Name:ACQUA CHIROPRACTIC SPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VERNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-300-2387
Mailing Address - Street 1:1730 PLYMOUTH RD STE 300
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-1932
Mailing Address - Country:US
Mailing Address - Phone:952-300-2387
Mailing Address - Fax:
Practice Address - Street 1:1730 PLYMOUTH RD STE 300
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1932
Practice Address - Country:US
Practice Address - Phone:952-300-2387
Practice Address - Fax:952-300-2386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
350003306Medicare PIN