Provider Demographics
NPI:1568416584
Name:HIGHLAND CHIROPRACTIC CENTER, P.A
Entity Type:Organization
Organization Name:HIGHLAND CHIROPRACTIC CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:FROEHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-698-6803
Mailing Address - Street 1:550 SNELLING AVE S
Mailing Address - Street 2:STE 203
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1564
Mailing Address - Country:US
Mailing Address - Phone:651-698-9680
Mailing Address - Fax:651-698-0445
Practice Address - Street 1:550 SNELLING AVE S
Practice Address - Street 2:STE 203
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1564
Practice Address - Country:US
Practice Address - Phone:651-698-6803
Practice Address - Fax:651-698-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN016327900Medicaid
MNT39652Medicare UPIN
MN016327900Medicaid