Provider Demographics
NPI:1790904571
Name:DR. PAUL C DEGLMANN DC, LLC
Entity Type:Organization
Organization Name:DR. PAUL C DEGLMANN DC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DEGLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-833-3038
Mailing Address - Street 1:6805 FLYING CLOUD DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-833-3038
Mailing Address - Fax:952-833-3040
Practice Address - Street 1:6805 FLYING CLOUD DRIVE
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-833-3038
Practice Address - Fax:952-833-3040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52OL7DROtherBCBS GROUP
MNC03958Medicare ID - Type UnspecifiedMEDICARE GROUP