Provider Demographics
NPI:1508868548
Name:WESTBY, PAUL A (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:WESTBY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 HIGHWAY 65 NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-5128
Mailing Address - Country:US
Mailing Address - Phone:763-571-1345
Mailing Address - Fax:763-571-2291
Practice Address - Street 1:6425 HIGHWAY 65 NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-5128
Practice Address - Country:US
Practice Address - Phone:763-571-1345
Practice Address - Fax:763-571-2291
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2001111N00000X
MN418171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN425227600Medicaid
MN1C01WEOtherBCBS
MN00085179OtherMN HEALTH
MN425227600Medicaid
T39448Medicare UPIN