Provider Demographics
NPI:1417231440
Name:DEVICH CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:DEVICH CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-741-4010
Mailing Address - Street 1:1510 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-3346
Mailing Address - Country:US
Mailing Address - Phone:218-741-4010
Mailing Address - Fax:218-741-0118
Practice Address - Street 1:1510 8TH ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3346
Practice Address - Country:US
Practice Address - Phone:218-741-4010
Practice Address - Fax:218-741-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4971044261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center