Provider Demographics
NPI:1457441800
Name:DULUTH CHIROPRACTIC CLINIC, PA
Entity Type:Organization
Organization Name:DULUTH CHIROPRACTIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-624-2452
Mailing Address - Street 1:5807 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2459
Mailing Address - Country:US
Mailing Address - Phone:218-624-2452
Mailing Address - Fax:218-624-6048
Practice Address - Street 1:5807 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2459
Practice Address - Country:US
Practice Address - Phone:218-624-2452
Practice Address - Fax:218-624-6048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C147DUOtherBLUE CROSS BLUE SHIELD
MN253173900Medicaid
MN231730OtherCHIROPRACTIC CARE OF MN
MN253173900Medicaid
MN3C147DUOtherBLUE CROSS BLUE SHIELD