Provider Demographics
NPI:1235479106
Name:MINNESOTA CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:MINNESOTA CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:651-216-6330
Mailing Address - Street 1:1959 SLOAN PL
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-2086
Mailing Address - Country:US
Mailing Address - Phone:651-216-6330
Mailing Address - Fax:
Practice Address - Street 1:1959 SLOAN PL
Practice Address - Street 2:SUITE 230
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-2086
Practice Address - Country:US
Practice Address - Phone:651-216-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty