Provider Demographics
NPI:1407124225
Name:DR. STEPHEN A. IRESTONE, PA.
Entity Type:Organization
Organization Name:DR. STEPHEN A. IRESTONE, PA.
Other - Org Name:HEALTH RESOURCES CHIROPRACTIC & NATUROPATHIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-895-7270
Mailing Address - Street 1:11970 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-1516
Mailing Address - Country:US
Mailing Address - Phone:952-895-7270
Mailing Address - Fax:952-895-1086
Practice Address - Street 1:11970 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-1516
Practice Address - Country:US
Practice Address - Phone:952-895-7270
Practice Address - Fax:952-895-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2115111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT39300Medicare UPIN
MN350001787Medicare PIN