Provider Demographics
NPI:1205117678
Name:PREMIER HEALTH OF PLYMOUTH LTD
Entity type:Organization
Organization Name:PREMIER HEALTH OF PLYMOUTH LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CHMIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-354-7880
Mailing Address - Street 1:5801 DULUTH ST STE 345
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-3952
Mailing Address - Country:US
Mailing Address - Phone:763-354-7880
Mailing Address - Fax:763-354-7882
Practice Address - Street 1:5801 DULUTH ST STE 345
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-3952
Practice Address - Country:US
Practice Address - Phone:763-354-7880
Practice Address - Fax:763-354-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-30
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5191111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306170618OtherNPI FOR MANAGING DOCTOR
MN1306170618Medicaid
MN1306170618OtherBCBS
1306170618OtherNPI FOR MANAGING DOCTOR