Provider Demographics
NPI:1962684621
Name:ALLIANCE CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:ALLIANCE CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-766-3855
Mailing Address - Street 1:3495 WILLOW LAKE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55110-5138
Mailing Address - Country:US
Mailing Address - Phone:651-766-3855
Mailing Address - Fax:651-766-7884
Practice Address - Street 1:3495 WILLOW LAKE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55110-5138
Practice Address - Country:US
Practice Address - Phone:651-766-3855
Practice Address - Fax:651-766-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN620261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center