Provider Demographics
NPI:1508984105
Name:PATHWAYS CHIROPRACTIC HEALTH CENTER OF SAVAGE, P.A.
Entity Type:Organization
Organization Name:PATHWAYS CHIROPRACTIC HEALTH CENTER OF SAVAGE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-226-5502
Mailing Address - Street 1:14233 OCONNELL CT STE 500
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2860
Mailing Address - Country:US
Mailing Address - Phone:952-226-5502
Mailing Address - Fax:952-226-5504
Practice Address - Street 1:14233 OCONNELL CT STE 500
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-2860
Practice Address - Country:US
Practice Address - Phone:952-226-5502
Practice Address - Fax:952-226-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3613111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4410386-00Medicaid
MN4410386-00Medicaid