Provider Demographics
NPI:1023222478
Name:VADNAIS HEIGHTS FAMILY CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:VADNAIS HEIGHTS FAMILY CHIROPRACTIC, INC.
Other - Org Name:PERFORMANCE CHIROPRACTIC AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JON
Authorized Official - Last Name:HALLINGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-762-7475
Mailing Address - Street 1:1038 CENTERVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6344
Mailing Address - Country:US
Mailing Address - Phone:651-762-7475
Mailing Address - Fax:651-762-7544
Practice Address - Street 1:1038 CENTERVILLE CIR
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-6344
Practice Address - Country:US
Practice Address - Phone:651-762-7475
Practice Address - Fax:651-762-7544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4396111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNBLUE CROSS BLUE SHIEOther056K3VA
MNBLUE CROSS BLUE SHIEOther056K3VA