Provider Demographics
NPI:1255563920
Name:PRIORITY HEALTH CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:PRIORITY HEALTH CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ZAIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-484-7738
Mailing Address - Street 1:47 N WATERVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:56057-1522
Mailing Address - Country:US
Mailing Address - Phone:952-484-7738
Mailing Address - Fax:
Practice Address - Street 1:47 N WATERVILLE AVE
Practice Address - Street 2:
Practice Address - City:LE CENTER
Practice Address - State:MN
Practice Address - Zip Code:56057-1522
Practice Address - Country:US
Practice Address - Phone:952-484-7738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5176111N00000X
MN5183111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty