Provider Demographics
NPI:1891901609
Name:PATHWAYS CHIROPRACTIC HEALTH CENTER OF PRIOR LAKE, PA
Entity Type:Organization
Organization Name:PATHWAYS CHIROPRACTIC HEALTH CENTER OF PRIOR LAKE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-447-3000
Mailing Address - Street 1:16154 MAIN AVE SE STE 134
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-4800
Mailing Address - Country:US
Mailing Address - Phone:952-447-3000
Mailing Address - Fax:952-447-3561
Practice Address - Street 1:16154 MAIN AVE SE STE 134
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4800
Practice Address - Country:US
Practice Address - Phone:952-447-3000
Practice Address - Fax:952-447-3561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2540111N00000X
MN3631111N00000X
MN3935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC02891Medicare PIN