Provider Demographics
NPI:1073810552
Name:BEMIDJI EXPLORE CHIROPRACTIC INCORPORATED
Entity Type:Organization
Organization Name:BEMIDJI EXPLORE CHIROPRACTIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HEADLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-333-8811
Mailing Address - Street 1:1426 BEMIDJI AVE N STE 2
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3882
Mailing Address - Country:US
Mailing Address - Phone:218-333-8811
Mailing Address - Fax:218-333-8813
Practice Address - Street 1:1426 BEMIDJI AVE N STE 2
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3882
Practice Address - Country:US
Practice Address - Phone:218-333-8811
Practice Address - Fax:218-333-8813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty