Provider Demographics
NPI:1558512632
Name:DANIELLE TREGO, PA
Entity Type:Organization
Organization Name:DANIELLE TREGO, PA
Other - Org Name:ACTIVE HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:TREGO
Authorized Official - Last Name:FINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-201-3420
Mailing Address - Street 1:423 FAIRVIEW AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1707
Mailing Address - Country:US
Mailing Address - Phone:952-201-3420
Mailing Address - Fax:651-304-1700
Practice Address - Street 1:50 CRETIN AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1042
Practice Address - Country:US
Practice Address - Phone:952-201-3420
Practice Address - Fax:651-304-1700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5115261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care