Provider Demographics
NPI:1326055468
Name:CHASE CHIROPRACTIC
Entity Type:Organization
Organization Name:CHASE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-862-4325
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515-0547
Mailing Address - Country:US
Mailing Address - Phone:218-862-4325
Mailing Address - Fax:
Practice Address - Street 1:104 MEMORY LANE
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515
Practice Address - Country:US
Practice Address - Phone:218-862-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB00876111N00000X
MN5653111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty