Provider Demographics
NPI:1093993693
Name:DUNIVAN, VIRGINIA PETRY (DC)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:PETRY
Last Name:DUNIVAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1953
Mailing Address - Country:US
Mailing Address - Phone:651-260-1763
Mailing Address - Fax:
Practice Address - Street 1:1746 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1953
Practice Address - Country:US
Practice Address - Phone:651-260-1763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4395111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004121Medicare PIN