Provider Demographics
NPI:1710128772
Name:REGIONAL HEALTH CENTER OF AVON, INC.
Entity Type:Organization
Organization Name:REGIONAL HEALTH CENTER OF AVON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:LOUREY DOLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-597-8999
Mailing Address - Street 1:307 IVY AVE SE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MN
Mailing Address - Zip Code:56368-4509
Mailing Address - Country:US
Mailing Address - Phone:320-597-8999
Mailing Address - Fax:320-597-8995
Practice Address - Street 1:300 AVON AVE S
Practice Address - Street 2:SUITE F
Practice Address - City:AVON
Practice Address - State:MN
Practice Address - Zip Code:56310-4528
Practice Address - Country:US
Practice Address - Phone:320-356-1023
Practice Address - Fax:320-356-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-20
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003166111N00000X
MN000299111N00000X
MN005167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty