Provider Demographics
NPI:1437295532
Name:BELDE CHIROPRACTIC CLINIC, PA
Entity Type:Organization
Organization Name:BELDE CHIROPRACTIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-295-4105
Mailing Address - Street 1:PO BOX 717
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-0717
Mailing Address - Country:US
Mailing Address - Phone:763-295-4105
Mailing Address - Fax:763-295-9116
Practice Address - Street 1:211 HIGHWAY 25 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-9306
Practice Address - Country:US
Practice Address - Phone:763-295-4105
Practice Address - Fax:763-295-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN771111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03912Medicare ID - Type UnspecifiedGROUP NUMBER