Provider Demographics
NPI:1205997293
Name:SLEEPY EYE CHIROPRACTIC PA
Entity type:Organization
Organization Name:SLEEPY EYE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KIRSCHSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-794-4971
Mailing Address - Street 1:201 2ND AVE SW
Mailing Address - Street 2:
Mailing Address - City:SLEEPY EYE
Mailing Address - State:MN
Mailing Address - Zip Code:56085-1316
Mailing Address - Country:US
Mailing Address - Phone:507-794-4971
Mailing Address - Fax:507-794-4971
Practice Address - Street 1:201 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:SLEEPY EYE
Practice Address - State:MN
Practice Address - Zip Code:56085-1316
Practice Address - Country:US
Practice Address - Phone:507-794-4971
Practice Address - Fax:507-794-4971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2388111N00000X
MN2589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2419882-00Medicaid
MN2419882-00Medicaid