Provider Demographics
NPI:1598926859
Name:BURNHAVEN CHIROPRACTIC
Entity Type:Organization
Organization Name:BURNHAVEN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:ROEHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-432-3777
Mailing Address - Street 1:14600 10TH AVE S
Mailing Address - Street 2:SUITE 600
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-4643
Mailing Address - Country:US
Mailing Address - Phone:952-432-3777
Mailing Address - Fax:
Practice Address - Street 1:14600 10TH AVE S
Practice Address - Street 2:SUITE 600
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-4643
Practice Address - Country:US
Practice Address - Phone:952-432-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2259MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty