Provider Demographics
NPI:1083350664
Name:CROSSTOWN CHIROPRACTIC PA
Entity Type:Organization
Organization Name:CROSSTOWN CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-382-9026
Mailing Address - Street 1:2330 CROSSTOWN BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:HAM LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4471
Mailing Address - Country:US
Mailing Address - Phone:507-382-9026
Mailing Address - Fax:
Practice Address - Street 1:2330 CROSSTOWN BLVD NE
Practice Address - Street 2:
Practice Address - City:HAM LAKE
Practice Address - State:MN
Practice Address - Zip Code:55304-4471
Practice Address - Country:US
Practice Address - Phone:763-434-5714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-06
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH100853627Medicaid