Provider Demographics
NPI:1568679264
Name:ADVANCED CHIROPRACTIC HEALTH
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-557-9032
Mailing Address - Street 1:4345 NATHAN LN N
Mailing Address - Street 2:STE F
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-4522
Mailing Address - Country:US
Mailing Address - Phone:763-536-1112
Mailing Address - Fax:763-536-0471
Practice Address - Street 1:4345 NATHAN LN N
Practice Address - Street 2:STE F
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-4522
Practice Address - Country:US
Practice Address - Phone:763-536-1112
Practice Address - Fax:763-536-0471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN110105600Medicaid
MN67G19W1OtherBCBS
MN110105600Medicaid