Provider Demographics
NPI:1639208739
Name:AFFORDABLE CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:AFFORDABLE CHIROPRACTIC CENTER, P.A.
Other - Org Name:ADVANCED SPINAL CARE & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-490-1507
Mailing Address - Street 1:4535 HODGSON RD
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-1949
Mailing Address - Country:US
Mailing Address - Phone:651-490-1507
Mailing Address - Fax:
Practice Address - Street 1:4535 HODGSON RD
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1949
Practice Address - Country:US
Practice Address - Phone:651-490-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2834111N00000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN126828700Medicaid
MN350004070OtherMEDICARE
MNC04876Medicare UPIN