Provider Demographics
NPI:1427211242
Name:BATTLE LAKE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BATTLE LAKE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-864-5813
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:202 LAKE AVENUE SOUTH
Mailing Address - City:BATTLE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56515-0632
Mailing Address - Country:US
Mailing Address - Phone:218-864-5813
Mailing Address - Fax:
Practice Address - Street 1:202 LAKE AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BATTLE LAKE
Practice Address - State:MN
Practice Address - Zip Code:56515-0632
Practice Address - Country:US
Practice Address - Phone:218-864-5813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty