Provider Demographics
NPI:1508078551
Name:ADVANCED CHIROPRACTIC OF APPLE VALLEY INC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF APPLE VALLEY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BS DC
Authorized Official - Phone:952-953-6100
Mailing Address - Street 1:7700 145TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5509
Mailing Address - Country:US
Mailing Address - Phone:952-953-6100
Mailing Address - Fax:952-953-6159
Practice Address - Street 1:7700 145TH ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-5509
Practice Address - Country:US
Practice Address - Phone:952-953-6100
Practice Address - Fax:952-953-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2180111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT66215Medicare UPIN
MNCO3552Medicare ID - Type Unspecified