Provider Demographics
NPI:1326056672
Name:SOUTH ST. PAUL FAMILY CHIROPRACTIC, LTD
Entity Type:Organization
Organization Name:SOUTH ST. PAUL FAMILY CHIROPRACTIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-450-2366
Mailing Address - Street 1:1345 THOMPSON AVE
Mailing Address - Street 2:P.O. BOX 122
Mailing Address - City:SOUTH ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55075-1410
Mailing Address - Country:US
Mailing Address - Phone:651-450-2366
Mailing Address - Fax:651-450-2388
Practice Address - Street 1:1345 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55075-1410
Practice Address - Country:US
Practice Address - Phone:651-450-2366
Practice Address - Fax:651-450-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN819680000Medicaid
MN026J9SOOtherBCBS
MNC04328OtherMEDICARE PTAN
MN350051301OtherRAILROAD MEDICARE
MNDF3118OtherRAILROAD MEDICARE
MNU84106Medicare UPIN
MN819680000Medicaid