Provider Demographics
NPI:1790968410
Name:HUGO CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:HUGO CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-429-9010
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:MN
Mailing Address - Zip Code:55038-0457
Mailing Address - Country:US
Mailing Address - Phone:651-429-9010
Mailing Address - Fax:651-429-2574
Practice Address - Street 1:5673 147TH ST N
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:MN
Practice Address - Zip Code:55038-9302
Practice Address - Country:US
Practice Address - Phone:651-429-9010
Practice Address - Fax:651-429-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC1502261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00477324OtherRAILROAD MEDICARE
MN040227300Medicaid
MN20446BAOtherBLUECROSSBLUESHIELD
MNP00477324OtherRAILROAD MEDICARE