DEEPHAVEN CHIROPRACTIC P.A. NPI 1790882785

NPI Information

  • NPI: 1790882785
  • Provider Name: DEEPHAVEN CHIROPRACTIC, P.A.
  • Classification: Chiropractor - 111N00000X
  • Entity Type: Organization
  • CLIA Number: 24D2076075
  • Address: 18281 MINNETONKA BLVD
    WAYZATA, MN
    ZIP 55391
  • Phone: (952) 475-0079

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NPI Details

DEEPHAVEN CHIROPRACTIC, P.A. is a chiropractor in Wayzata, MN. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. DEEPHAVEN CHIROPRACTIC, P.A. NPI is 1790882785. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

18281 MINNETONKA BLVD
WAYZATA, MN
ZIP 55391-345
Phone: (952) 475-0079
Fax: (952) 475-1030

The provider's authorized official is Tammy Jo Love .
The authorized official title is Ceo and has the following contact phone number (952) 475-0079.

The CLIA number assigned to this NPI record is 24D2076075 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 1/14/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractor3658MINNESOTAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
160B90DEOTHERMINNESOTABCBS
2U82339MEDICARE UPINMINNESOTA
3U82339OTHERMINNESOTAMETROPOLITAN HEALTH PLAN
4C02880MEDICARE ID-TYPE UNSPECIFIEDMINNESOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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