Provider Demographics
NPI:1992864961
Name:COMPLETE CHIROPRACTIC HEALTH SERVICES, P.A.
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC HEALTH SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HAFNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-690-9366
Mailing Address - Street 1:1526 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105
Mailing Address - Country:US
Mailing Address - Phone:651-690-9366
Mailing Address - Fax:
Practice Address - Street 1:1526 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105
Practice Address - Country:US
Practice Address - Phone:651-690-9366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN939273400Medicaid
MN27377REOtherBCBS CLINIC NUMBER