Provider Demographics
NPI:1700026762
Name:SAWTOOTH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SAWTOOTH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALIN
Authorized Official - Middle Name:ELISABETH
Authorized Official - Last Name:ASEBY-GESCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-387-2383
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:GRAND MARAIS
Mailing Address - State:MN
Mailing Address - Zip Code:55604-0158
Mailing Address - Country:US
Mailing Address - Phone:218-387-2383
Mailing Address - Fax:218-387-2383
Practice Address - Street 1:501 W 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND MARAIS
Practice Address - State:MN
Practice Address - Zip Code:55604
Practice Address - Country:US
Practice Address - Phone:218-387-2383
Practice Address - Fax:218-387-2383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN723111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350051297OtherMEDICARE RAILROAD
MN29G39GEOtherBC/BS OF MN INDIVIDUAL
MN29G38SAOtherBC/BS OF MN BUSINESS
MN1538269675OtherNPI INDIVIDUAL
MN3570193-00Medicaid
MN3570193-00Medicaid
MN350002091Medicare PIN