Provider Demographics
NPI:1184766842
Name:ANOKA-ANDOVER CHIROPRACTIC, PA
Entity type:Organization
Organization Name:ANOKA-ANDOVER CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BILLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-427-7122
Mailing Address - Street 1:3722 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1465
Mailing Address - Country:US
Mailing Address - Phone:763-427-7122
Mailing Address - Fax:763-427-4042
Practice Address - Street 1:3722 7TH AVE
Practice Address - Street 2:
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1465
Practice Address - Country:US
Practice Address - Phone:763-427-7122
Practice Address - Fax:763-427-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN510221000OtherMN MEDICAL ASS. GROUP
MN20735BIOtherBLUE CROSS BLUE SHIELD
MN625327000OtherMN MEDICAL ASS. INDIVDUAL
MN3710867Medicaid
MNOG117BIOtherGROUP BLUE CROSS BLUE SHI
MN3710867Medicaid