Provider Demographics
NPI:1699034850
Name:PRINCETON BACK AND NECK CLINIC PA
Entity Type:Organization
Organization Name:PRINCETON BACK AND NECK CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:VANHOOSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-631-2225
Mailing Address - Street 1:209 RUM RIVER DR N
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1609
Mailing Address - Country:US
Mailing Address - Phone:763-631-2225
Mailing Address - Fax:
Practice Address - Street 1:209 RUM RIVER DR N
Practice Address - Street 2:SUITE 2
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1609
Practice Address - Country:US
Practice Address - Phone:763-631-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004181OtherMEDICARE PTAN