Provider Demographics
NPI:1891961645
Name:EAGAN CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:EAGAN CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEISCHHACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-688-0462
Mailing Address - Street 1:1565 CLIFF ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2574
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1565 CLIFF ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2574
Practice Address - Country:US
Practice Address - Phone:651-688-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3225111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN280428000Medicaid
MN280428000Medicaid
MNCO2743Medicare PIN