Provider Demographics
NPI:1275711764
Name:Y-CHIROPRACTIC
Entity Type:Organization
Organization Name:Y-CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAEBOO
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-543-9080
Mailing Address - Street 1:10700 HIGHWAY 55
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6100
Mailing Address - Country:US
Mailing Address - Phone:763-543-9080
Mailing Address - Fax:763-543-9082
Practice Address - Street 1:10700 HIGHWAY 55
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6100
Practice Address - Country:US
Practice Address - Phone:763-543-9080
Practice Address - Fax:763-543-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02723Medicare PIN