Provider Demographics
NPI:1689868499
Name:JOSEPH SUTCLIFFE P.A.
Entity Type:Organization
Organization Name:JOSEPH SUTCLIFFE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SUTCLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-448-4222
Mailing Address - Street 1:424 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2091
Mailing Address - Country:US
Mailing Address - Phone:952-448-4222
Mailing Address - Fax:952-448-5393
Practice Address - Street 1:424 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2091
Practice Address - Country:US
Practice Address - Phone:952-448-4222
Practice Address - Fax:952-448-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO3779OtherMEDICARE GROUP
MN339K6SUOtherBLUE CROSS BLUE SHIELD
MN339K6SUOtherBLUE CROSS BLUE SHIELD