Provider Demographics
NPI:1518146687
Name:CASCADE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:CASCADE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:MARISTUEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-227-2233
Mailing Address - Street 1:1390 7TH ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-4206
Mailing Address - Country:US
Mailing Address - Phone:651-227-2233
Mailing Address - Fax:651-528-7309
Practice Address - Street 1:1390 W. 7TH STREET
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-227-2233
Practice Address - Fax:651-528-7309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003516OtherNOT SURE WHICH CATEGORY
MN350003516OtherNOT SURE WHICH CATEGORY