Provider Demographics
NPI:1467630293
Name:MBH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MBH CHIROPRACTIC, LLC
Other - Org Name:MBH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE BURNETT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-839-4124
Mailing Address - Street 1:1080 RAYMOND AVE
Mailing Address - Street 2:#18
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1540
Mailing Address - Country:US
Mailing Address - Phone:651-646-0662
Mailing Address - Fax:651-646-1372
Practice Address - Street 1:1080 RAYMOND AVE
Practice Address - Street 2:#18
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1540
Practice Address - Country:US
Practice Address - Phone:651-646-0662
Practice Address - Fax:651-646-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty