Provider Demographics
NPI:1356421317
Name:NORTH ST PAUL CHIROPRACTIC OFFICE, P.A.
Entity type:Organization
Organization Name:NORTH ST PAUL CHIROPRACTIC OFFICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-770-3805
Mailing Address - Street 1:2516 7TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3003
Mailing Address - Country:US
Mailing Address - Phone:651-770-3805
Mailing Address - Fax:651-747-8737
Practice Address - Street 1:2516 7TH AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3003
Practice Address - Country:US
Practice Address - Phone:651-770-3805
Practice Address - Fax:651-747-8737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1160MNDC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty