Provider Demographics
NPI:1245364124
Name:ARVOLD, BRIAN LEE (DC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:ARVOLD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5685 GENEVA AVE. N.
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1018
Mailing Address - Country:US
Mailing Address - Phone:651-770-2283
Mailing Address - Fax:651-770-8842
Practice Address - Street 1:5685 GENEVA AVE. N.
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-1018
Practice Address - Country:US
Practice Address - Phone:651-770-2283
Practice Address - Fax:651-770-8842
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN77489OtherHEALTH PARTNERS
MN96D63AROtherBCBS