Provider Demographics
NPI:1003937640
Name:EISWALD, CHAD ALAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:ALAN
Last Name:EISWALD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 BENTON WAY
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3756
Mailing Address - Country:US
Mailing Address - Phone:651-481-0184
Mailing Address - Fax:651-486-0697
Practice Address - Street 1:3434 LEXINGTON AVE N
Practice Address - Street 2:SUITE 900
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8069
Practice Address - Country:US
Practice Address - Phone:651-484-4000
Practice Address - Fax:651-486-0697
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3512111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU-76775Medicare UPIN