Provider Demographics
NPI:1447430228
Name:INSPIRED CHIROPRACTIC
Entity Type:Organization
Organization Name:INSPIRED CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:H
Authorized Official - Last Name:EDLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-351-5070
Mailing Address - Street 1:210 3RD ST N
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55003-1027
Mailing Address - Country:US
Mailing Address - Phone:651-351-5057
Mailing Address - Fax:651-351-3198
Practice Address - Street 1:210 3RD ST N
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:MN
Practice Address - Zip Code:55003-1027
Practice Address - Country:US
Practice Address - Phone:651-351-5057
Practice Address - Fax:651-351-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN224645OtherHEALTHPARTNERS
MN99M88INOtherBCBS OF MN
MN99M88INOtherBCBS OF MN
MNCO4760Medicare PIN