Provider Demographics
NPI:1457431827
Name:AAGESEN CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:AAGESEN CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:AAGESEN-REZNECHECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-920-1092
Mailing Address - Street 1:5050 W 36TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5469
Mailing Address - Country:US
Mailing Address - Phone:612-920-1092
Mailing Address - Fax:612-928-0376
Practice Address - Street 1:5050 W 36TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5469
Practice Address - Country:US
Practice Address - Phone:612-920-1092
Practice Address - Fax:612-928-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN372M6AAOtherBCBS OT GROUP ID
MN59836AAOtherBCBS CHIROPRACTIC GRP ID
MN31P34AAOtherBCBS PT GROUP ID
MN31P34AAOtherBCBS PT GROUP ID