Provider Demographics
NPI:1467818187
Name:ADA CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:ADA CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:MENGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-784-2330
Mailing Address - Street 1:406 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MN
Mailing Address - Zip Code:56510-1342
Mailing Address - Country:US
Mailing Address - Phone:218-784-2330
Mailing Address - Fax:218-784-2330
Practice Address - Street 1:406 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MN
Practice Address - Zip Code:56510-1342
Practice Address - Country:US
Practice Address - Phone:218-784-2330
Practice Address - Fax:218-784-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty