Provider Demographics
NPI:1669811295
Name:VAAGENES CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:VAAGENES CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:VAAGENES
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:651-415-0446
Mailing Address - Street 1:2508 HIGHWAY 70
Mailing Address - Street 2:PO BOX 385
Mailing Address - City:BRAHAM
Mailing Address - State:MN
Mailing Address - Zip Code:55006-3759
Mailing Address - Country:US
Mailing Address - Phone:651-415-0446
Mailing Address - Fax:651-415-0447
Practice Address - Street 1:470 HIGHWAY 96 W
Practice Address - Street 2:SUITE 160
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-1996
Practice Address - Country:US
Practice Address - Phone:651-415-0446
Practice Address - Fax:651-415-0447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3144261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care