Provider Demographics
NPI:1588842009
Name:CHIROPRACTIC ASSOCIATES OF NORTHERN MINNESOTA, LTD.
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF NORTHERN MINNESOTA, LTD.
Other - Org Name:ASSOCIATED CHIROPRACTIC PHYSICIANS/ MILLER HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAF
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:LESAVAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-722-9300
Mailing Address - Street 1:224 PAINE FARM RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-2607
Mailing Address - Country:US
Mailing Address - Phone:218-722-9300
Mailing Address - Fax:218-722-9415
Practice Address - Street 1:1301 MILLER TRUNK HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-5611
Practice Address - Country:US
Practice Address - Phone:218-722-9300
Practice Address - Fax:218-722-9415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52485LEOtherBLUE CROSS BLUE SHIELD