Provider Demographics
NPI:1649678517
Name:CASUAL CHIROPRACTIC
Entity type:Organization
Organization Name:CASUAL CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-789-0970
Mailing Address - Street 1:555 7TH ST W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-3067
Mailing Address - Country:US
Mailing Address - Phone:651-789-0970
Mailing Address - Fax:651-789-0971
Practice Address - Street 1:555 7TH ST W
Practice Address - Street 2:SUITE 201
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-3067
Practice Address - Country:US
Practice Address - Phone:651-789-0970
Practice Address - Fax:651-789-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty