Provider Demographics
NPI:1457491862
Name:MCBRIDE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:MCBRIDE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:218-326-2828
Mailing Address - Street 1:1751 SE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2586
Mailing Address - Country:US
Mailing Address - Phone:218-326-2828
Mailing Address - Fax:218-326-2516
Practice Address - Street 1:1751 SE 2ND AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2586
Practice Address - Country:US
Practice Address - Phone:218-326-2828
Practice Address - Fax:218-326-2516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN767326400Medicaid
MNP00067312OtherRAILROAD MEDICARE
MN3C527MCOtherBLUE CROSS BLUE SHIELD
MNC03380Medicare ID - Type Unspecified
MNU35657Medicare UPIN