Provider Demographics
NPI:1417153925
Name:LAMPPA CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:LAMPPA CHIROPRACTIC, PA
Other - Org Name:ACTIVE LIFE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LAMPPA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-888-6000
Mailing Address - Street 1:8900 PENN AVE. S
Mailing Address - Street 2:STE. 100
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431
Mailing Address - Country:US
Mailing Address - Phone:952-888-6000
Mailing Address - Fax:952-888-4179
Practice Address - Street 1:8900 PENN AVE. S
Practice Address - Street 2:STE. 100
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431
Practice Address - Country:US
Practice Address - Phone:952-888-6000
Practice Address - Fax:952-888-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51214LAMedicare UPIN
MNC04149Medicare ID - Type Unspecified