Provider Demographics
NPI:1376832485
Name:NEUBAUER CHIROPRACTIC HEALTH CENTER, PA
Entity Type:Organization
Organization Name:NEUBAUER CHIROPRACTIC HEALTH CENTER, PA
Other - Org Name:DBA HEALTHSOURCE OF CHASKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:NEUBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-442-9876
Mailing Address - Street 1:20 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1020
Mailing Address - Country:US
Mailing Address - Phone:952-442-9876
Mailing Address - Fax:952-442-2494
Practice Address - Street 1:122 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1167
Practice Address - Country:US
Practice Address - Phone:952-361-4844
Practice Address - Fax:952-368-7126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1972353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty