Provider Demographics
NPI:1578873642
Name:PREFERRED CHIROPRACTIC ASSOCIATES INC
Entity Type:Organization
Organization Name:PREFERRED CHIROPRACTIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-481-1488
Mailing Address - Street 1:3570 LEXINGTON AVE N
Mailing Address - Street 2:#208
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126
Mailing Address - Country:US
Mailing Address - Phone:651-481-1488
Mailing Address - Fax:651-481-8051
Practice Address - Street 1:3570 LEXINGTON AVE N
Practice Address - Street 2:#208
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8049
Practice Address - Country:US
Practice Address - Phone:651-481-1488
Practice Address - Fax:651-481-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
350002307Medicare UPIN