Provider Demographics
NPI:1477709814
Name:NORTHLAND CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:NORTHLAND CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:OSCARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-430-2727
Mailing Address - Street 1:1675 GREELEY ST S
Mailing Address - Street 2:#102
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-6091
Mailing Address - Country:US
Mailing Address - Phone:651-430-2727
Mailing Address - Fax:651-430-2727
Practice Address - Street 1:1675 GREELEY ST S
Practice Address - Street 2:#102
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6091
Practice Address - Country:US
Practice Address - Phone:651-430-2727
Practice Address - Fax:651-430-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4122111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350002430Medicare PIN