Provider Demographics
NPI:1376967489
Name:EAST ST PAUL HEALTH PA
Entity Type:Organization
Organization Name:EAST ST PAUL HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-487-2198
Mailing Address - Street 1:1601 LARPENTEUR AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5702
Mailing Address - Country:US
Mailing Address - Phone:651-487-2198
Mailing Address - Fax:
Practice Address - Street 1:779 7TH ST E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-5029
Practice Address - Country:US
Practice Address - Phone:651-888-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4474-12111N00000X
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty