Provider Demographics
NPI:1184840019
Name:UNIVERSAL CHIROPRACTIC HEALTH CLINIC
Entity type:Organization
Organization Name:UNIVERSAL CHIROPRACTIC HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRAK
Authorized Official - Middle Name:ASSEGIE
Authorized Official - Last Name:HAILU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-647-9100
Mailing Address - Street 1:671 SNELLING AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1839
Mailing Address - Country:US
Mailing Address - Phone:651-647-9100
Mailing Address - Fax:651-641-0450
Practice Address - Street 1:671 SNELLING AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-1839
Practice Address - Country:US
Practice Address - Phone:651-647-9100
Practice Address - Fax:651-641-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty