Provider Demographics
NPI:1407125099
Name:SIMPLY CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:SIMPLY CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRIEDRICHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-762-4757
Mailing Address - Street 1:4886 HIGHWAY 61 N
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-2857
Mailing Address - Country:US
Mailing Address - Phone:651-762-4757
Mailing Address - Fax:
Practice Address - Street 1:4886 HIGHWAY 61 N
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-2857
Practice Address - Country:US
Practice Address - Phone:651-762-4757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLY CHIROPRACTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5081111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1912185448OtherNPI PERSONAL