Provider Demographics
NPI:1750443255
Name:WARNER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:WARNER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:CORINNE
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-789-1010
Mailing Address - Street 1:2726 JOHNSON ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-3042
Mailing Address - Country:US
Mailing Address - Phone:612-789-1010
Mailing Address - Fax:612-789-9205
Practice Address - Street 1:2726 JOHNSON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-3042
Practice Address - Country:US
Practice Address - Phone:612-789-1010
Practice Address - Fax:612-789-9205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN981222003OtherMPH
MN44-40056OtherMEDICA
MN326228600Medicaid
MN3C806WAOtherBLUE CROSS BLUE SHIELD
MN231031OtherACN
MN326228600Medicaid
MN231031OtherACN
MN44-40056OtherMEDICA
MNT39942Medicare UPIN