Provider Demographics
NPI:1902016710
Name:NEWMAN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:NEWMAN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:DAVIS
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-546-7030
Mailing Address - Street 1:29141 UNDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4629
Mailing Address - Country:US
Mailing Address - Phone:218-820-7936
Mailing Address - Fax:
Practice Address - Street 1:10 W HIGHWAY 2 STE A
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MN
Practice Address - Zip Code:55721-8614
Practice Address - Country:US
Practice Address - Phone:218-820-7936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2918111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN689452600Medicaid
MN72M00NEOtherBCBS INDIV PROVIDER ID
MN71M99CROtherBCBS CLINIC ID
MN689452600Medicaid
MN71M99CROtherBCBS CLINIC ID