Provider Demographics
NPI:1376793356
Name:DELANO CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:DELANO CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-972-2215
Mailing Address - Street 1:PO BOX 646
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-0646
Mailing Address - Country:US
Mailing Address - Phone:763-972-2215
Mailing Address - Fax:763-972-9723
Practice Address - Street 1:120 BRIDGE AVE W
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-9384
Practice Address - Country:US
Practice Address - Phone:763-972-2215
Practice Address - Fax:763-972-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC 4061111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty