Provider Demographics
NPI:1669611521
Name:PHELPS CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:PHELPS CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVERN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:218-365-4044
Mailing Address - Street 1:22 E CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1280
Mailing Address - Country:US
Mailing Address - Phone:218-365-4044
Mailing Address - Fax:218-365-4044
Practice Address - Street 1:22 E CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1280
Practice Address - Country:US
Practice Address - Phone:218-365-4044
Practice Address - Fax:218-365-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty