Provider Demographics
NPI:1790053593
Name:DUNCAN CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:DUNCAN CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-464-4199
Mailing Address - Street 1:707 WEST BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1408
Mailing Address - Country:US
Mailing Address - Phone:651-464-4199
Mailing Address - Fax:651-464-4202
Practice Address - Street 1:707 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1408
Practice Address - Country:US
Practice Address - Phone:651-464-4199
Practice Address - Fax:651-464-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1337261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center