Provider Demographics
NPI:1417228214
Name:MCCALLUM CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:MCCALLUM CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCCALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-572-2322
Mailing Address - Street 1:4911 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1912
Mailing Address - Country:US
Mailing Address - Phone:763-572-2322
Mailing Address - Fax:763-572-2322
Practice Address - Street 1:4911 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:COLUMBIA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55421-1912
Practice Address - Country:US
Practice Address - Phone:763-572-2322
Practice Address - Fax:763-572-2322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty