Provider Demographics
NPI:1346447471
Name:ASPENRIDGE CHIROPRACTIC CENTER P.A.
Entity Type:Organization
Organization Name:ASPENRIDGE CHIROPRACTIC CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SPILLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-879-5831
Mailing Address - Street 1:2511 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-2845
Mailing Address - Country:US
Mailing Address - Phone:218-879-5831
Mailing Address - Fax:
Practice Address - Street 1:2511 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLOQUET
Practice Address - State:MN
Practice Address - Zip Code:55720-2845
Practice Address - Country:US
Practice Address - Phone:218-879-5831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3901261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8279659-00Medicaid
MN8279659-00Medicaid