Provider Demographics
NPI:1972968337
Name:CORE CHIROPRACTIC & HEALTH
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC & HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:KAMPMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-493-0701
Mailing Address - Street 1:219 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-1800
Mailing Address - Country:US
Mailing Address - Phone:516-493-0701
Mailing Address - Fax:651-674-3651
Practice Address - Street 1:219 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MAHTOMEDI
Practice Address - State:MN
Practice Address - Zip Code:55115-1800
Practice Address - Country:US
Practice Address - Phone:516-493-0701
Practice Address - Fax:651-674-3651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MN4977261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN692635000Medicaid
MN692635000Medicaid