Provider Demographics
NPI:1710158621
Name:VAIL CHIROPRACTIC CLINIC PLLC
Entity Type:Organization
Organization Name:VAIL CHIROPRACTIC CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-474-4260
Mailing Address - Street 1:902 E 2ND ST STE 301
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6516
Mailing Address - Country:US
Mailing Address - Phone:507-474-4260
Mailing Address - Fax:507-474-4262
Practice Address - Street 1:902 E 2ND ST STE 301
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6516
Practice Address - Country:US
Practice Address - Phone:507-474-4260
Practice Address - Fax:507-474-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4671261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003310OtherMEDICARE
WI38979300Medicaid
MN570697100Medicaid