Provider Demographics
NPI:1326259318
Name:CARON CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:CARON CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:CARON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-699-6044
Mailing Address - Street 1:1021 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-7037
Mailing Address - Country:US
Mailing Address - Phone:651-699-6044
Mailing Address - Fax:651-699-2065
Practice Address - Street 1:490 SNELLING AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1501
Practice Address - Country:US
Practice Address - Phone:651-699-6044
Practice Address - Fax:651-699-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty