Provider Demographics
NPI:1225180359
Name:CHIROPRACTIC HEALTH CARE OF ST. PAUL P.A.
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CARE OF ST. PAUL P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-293-9200
Mailing Address - Street 1:1386 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4206
Mailing Address - Country:US
Mailing Address - Phone:651-293-9200
Mailing Address - Fax:
Practice Address - Street 1:1386 7TH ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4206
Practice Address - Country:US
Practice Address - Phone:651-293-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN06070GROtherBCBSM
MN06070GROtherBCBSM