Provider Demographics
NPI:1497528863
Name:CORREA CHIROPRACTIC SPORT AND INJUTY REHAB
Entity Type:Organization
Organization Name:CORREA CHIROPRACTIC SPORT AND INJUTY REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARILY
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-332-9494
Mailing Address - Street 1:14532 HAYES RD
Mailing Address - Street 2:LOWER
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7450
Mailing Address - Country:US
Mailing Address - Phone:651-332-9494
Mailing Address - Fax:
Practice Address - Street 1:14532 HAYES RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7450
Practice Address - Country:US
Practice Address - Phone:651-332-9494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center