Provider Demographics
NPI:1003120643
Name:ALAN ARVIDSON CHIROPRACTIC CLINIC P.A.
Entity Type:Organization
Organization Name:ALAN ARVIDSON CHIROPRACTIC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ARVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-633-4938
Mailing Address - Street 1:2030 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-5301
Mailing Address - Country:US
Mailing Address - Phone:651-633-4938
Mailing Address - Fax:651-633-0355
Practice Address - Street 1:2030 SILVER LAKE RD NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5301
Practice Address - Country:US
Practice Address - Phone:651-633-4938
Practice Address - Fax:651-633-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001730-7111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA350037740OtherRAILROAD MEDICARE
GA350037740OtherRAILROAD MEDICARE
MN350002897Medicare PIN