Provider Demographics
NPI:1184708117
Name:A CENTER FOR CHIROPRACTIC AND ACUPUNTURE PA
Entity type:Organization
Organization Name:A CENTER FOR CHIROPRACTIC AND ACUPUNTURE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-739-2225
Mailing Address - Street 1:1803 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2910
Mailing Address - Country:US
Mailing Address - Phone:651-739-2225
Mailing Address - Fax:651-739-3313
Practice Address - Street 1:1803 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2910
Practice Address - Country:US
Practice Address - Phone:651-739-2225
Practice Address - Fax:651-739-3313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3627687261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN769984100Medicaid
MNC02494Medicare UPIN
MNC02494Medicare ID - Type UnspecifiedGROUP ID NUMBER