Provider Demographics
NPI:1659424919
Name:PHELPS, LAVERN A JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LAVERN
Middle Name:A
Last Name:PHELPS
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 E CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1228
Mailing Address - Country:US
Mailing Address - Phone:218-365-4044
Mailing Address - Fax:218-365-3249
Practice Address - Street 1:22 E CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1228
Practice Address - Country:US
Practice Address - Phone:218-365-4044
Practice Address - Fax:218-365-3249
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2697111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231027OtherCHIROCARE
MN62523PLOtherBCBSMN
MN62523PLOtherBCBSMN