Provider Demographics
NPI:1467578518
Name:ALIGN CHIROMEDICAL CLINIC, P.A.
Entity Type:Organization
Organization Name:ALIGN CHIROMEDICAL CLINIC, P.A.
Other - Org Name:ALIGN CHIROMEDICAL CLINIC, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-690-0866
Mailing Address - Street 1:33 HAMLINE AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2231
Mailing Address - Country:US
Mailing Address - Phone:651-690-0866
Mailing Address - Fax:651-690-0031
Practice Address - Street 1:33 HAMLINE AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2231
Practice Address - Country:US
Practice Address - Phone:651-690-0866
Practice Address - Fax:651-690-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MN03221261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C482-ALOtherPROVIDER NUMBER