Provider Demographics
NPI:1114284064
Name:CENTERED HEALTH CHIROPRACTIC P A
Entity Type:Organization
Organization Name:CENTERED HEALTH CHIROPRACTIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CENTERED HEALTH CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SLETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-710-5523
Mailing Address - Street 1:9920 FOLEY BLVD NW SUITE 140
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433
Mailing Address - Country:US
Mailing Address - Phone:763-710-5523
Mailing Address - Fax:763-710-5532
Practice Address - Street 1:9920 FOLEY BLVD NW SUITE 140
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433
Practice Address - Country:US
Practice Address - Phone:763-710-5523
Practice Address - Fax:763-710-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty