Provider Demographics
NPI:1518963768
Name:NEW BRIGHTON CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:NEW BRIGHTON CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:KOLLAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-636-4120
Mailing Address - Street 1:2216 COUNTY ROAD D W STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-8505
Mailing Address - Country:US
Mailing Address - Phone:651-636-4120
Mailing Address - Fax:651-630-1069
Practice Address - Street 1:2216 COUNTY ROAD D W STE B
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-8505
Practice Address - Country:US
Practice Address - Phone:651-636-4120
Practice Address - Fax:651-630-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN580111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN137L0NEOtherBCBS CLINIC ID
MNC03306Medicare ID - Type UnspecifiedMEDICARE GROUP