Provider Demographics
NPI:1326194788
Name:HAILU, SIRAK ASSEGIE (DC)
Entity Type:Individual
Prefix:DR
First Name:SIRAK
Middle Name:ASSEGIE
Last Name:HAILU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 SNELLING AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1839
Mailing Address - Country:US
Mailing Address - Phone:651-647-9100
Mailing Address - Fax:651-641-0450
Practice Address - Street 1:671 SNELLING AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1839
Practice Address - Country:US
Practice Address - Phone:651-647-9100
Practice Address - Fax:651-641-0450
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor