Provider Demographics
NPI:1407050891
Name:RIVER VALLEY SPINAL HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:RIVER VALLEY SPINAL HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAPPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-437-4555
Mailing Address - Street 1:800 OAK ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-2361
Mailing Address - Country:US
Mailing Address - Phone:651-437-4555
Mailing Address - Fax:651-438-3128
Practice Address - Street 1:800 OAK ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2361
Practice Address - Country:US
Practice Address - Phone:651-437-4555
Practice Address - Fax:651-438-3128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350000865Medicare PIN
MN1C C01533Medicare PIN