Provider Demographics
NPI:1437233814
Name:HOMECARE CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:HOMECARE CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STAEHELI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-331-9999
Mailing Address - Street 1:3636 OAK CREEK TER
Mailing Address - Street 2:
Mailing Address - City:VADNAIS HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55127-7034
Mailing Address - Country:US
Mailing Address - Phone:612-331-9999
Mailing Address - Fax:612-331-9990
Practice Address - Street 1:3636 OAK CREEK TER
Practice Address - Street 2:
Practice Address - City:VADNAIS HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55127-7034
Practice Address - Country:US
Practice Address - Phone:612-331-9999
Practice Address - Fax:612-331-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02596Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER