Provider Demographics
NPI:1578781449
Name:WEST METRO CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:WEST METRO CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HORBAL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-544-9667
Mailing Address - Street 1:2756 DOUGLAS DR N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2402
Mailing Address - Country:US
Mailing Address - Phone:763-544-9667
Mailing Address - Fax:763-544-9823
Practice Address - Street 1:2756 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2402
Practice Address - Country:US
Practice Address - Phone:763-554-9667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62510HOOtherBCBS PROVIDER NUMBER
MN0B109HOOtherBCBS PROVIDER NUMBER
1306928957OtherPROVIDER NPI