Provider Demographics
NPI:1437310711
Name:ACORN CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ACORN CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:PETRY
Authorized Official - Last Name:DUNIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-260-1763
Mailing Address - Street 1:1746 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1953
Mailing Address - Country:US
Mailing Address - Phone:651-260-1763
Mailing Address - Fax:
Practice Address - Street 1:1746 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1953
Practice Address - Country:US
Practice Address - Phone:651-260-1763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4395111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04944Medicare PIN