Provider Demographics
NPI:1467642843
Name:LANDRY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:LANDRY CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:LANDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-702-9012
Mailing Address - Street 1:19449 EVANS ST NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-1074
Mailing Address - Country:US
Mailing Address - Phone:612-702-9012
Mailing Address - Fax:736-633-0039
Practice Address - Street 1:19449 EVANS ST NW
Practice Address - Street 2:SUITE A
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-1074
Practice Address - Country:US
Practice Address - Phone:612-702-9012
Practice Address - Fax:736-633-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45D48LAOtherBCBS PIN
MN94631OtherHEALTH PARTNERS ID.
MN4487073OtherMEDICA ID.
MN94631OtherHEALTH PARTNERS ID.