Provider Demographics
NPI:1104865179
Name:AMELI CHIROPRACTIC CLINIC P.A.
Entity Type:Organization
Organization Name:AMELI CHIROPRACTIC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMELI
Authorized Official - Suffix:
Authorized Official - Credentials:DC DACAN
Authorized Official - Phone:952-432-0700
Mailing Address - Street 1:14635 PENNOCK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-6430
Mailing Address - Country:US
Mailing Address - Phone:952-432-0700
Mailing Address - Fax:952-432-0701
Practice Address - Street 1:14635 PENNOCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6430
Practice Address - Country:US
Practice Address - Phone:952-432-0700
Practice Address - Fax:952-432-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC00887Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER