Provider Demographics
NPI:1760502850
Name:ARVOLD CHIROPRACTIC
Entity Type:Organization
Organization Name:ARVOLD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ARVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-770-2283
Mailing Address - Street 1:5685 GENEVA AVE. N.
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1018
Mailing Address - Country:US
Mailing Address - Phone:651-770-2283
Mailing Address - Fax:651-770-8842
Practice Address - Street 1:5685 GENEVA AVE. N.
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-1018
Practice Address - Country:US
Practice Address - Phone:651-770-2283
Practice Address - Fax:651-770-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003802261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03156Medicare ID - Type UnspecifiedGROUP #