Provider Demographics
NPI:1669863395
Name:YER CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:YER CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YER
Authorized Official - Middle Name:TON
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-605-5410
Mailing Address - Street 1:1497 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2414
Mailing Address - Country:US
Mailing Address - Phone:651-605-5410
Mailing Address - Fax:651-776-2415
Practice Address - Street 1:1497 WHITE BEAR AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2414
Practice Address - Country:US
Practice Address - Phone:651-605-5410
Practice Address - Fax:651-776-2415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty