Provider Demographics
NPI:1710902028
Name:CENTRAL CHIROPRACTIC & ACUPUNCTURE, P.A.
Entity Type:Organization
Organization Name:CENTRAL CHIROPRACTIC & ACUPUNCTURE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KOHOUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-784-3916
Mailing Address - Street 1:1342 81ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55432-2116
Mailing Address - Country:US
Mailing Address - Phone:763-784-3916
Mailing Address - Fax:763-784-3829
Practice Address - Street 1:1342 81ST AVE NE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE PARK
Practice Address - State:MN
Practice Address - Zip Code:55432-2116
Practice Address - Country:US
Practice Address - Phone:763-784-3916
Practice Address - Fax:763-784-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2616111N00000X
MN114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C916KOOtherBCBS OF MN