Provider Demographics
NPI:1598066086
Name:AGADA CHIROPRACTIC AND INTEGRATIVE HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:AGADA CHIROPRACTIC AND INTEGRATIVE HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-405-6263
Mailing Address - Street 1:3311 COUNTY ROAD 101 S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-2866
Mailing Address - Country:US
Mailing Address - Phone:952-405-6263
Mailing Address - Fax:952-406-8060
Practice Address - Street 1:3311 COUNTY ROAD 101 S
Practice Address - Street 2:SUITE 2
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-2866
Practice Address - Country:US
Practice Address - Phone:952-405-6263
Practice Address - Fax:952-406-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty