Provider Demographics
NPI:1003016296
Name:SLP CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:SLP CHIROPRACTIC, PA
Other - Org Name:DAVIS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-925-4085
Mailing Address - Street 1:6140 LAKE LINDEN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-2954
Mailing Address - Country:US
Mailing Address - Phone:952-474-0886
Mailing Address - Fax:
Practice Address - Street 1:6140 LAKE LINDEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-2954
Practice Address - Country:US
Practice Address - Phone:952-474-0886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty