Provider Demographics
NPI:1720153745
Name:NORTHGATE HEALTH CLINIC, P.A.
Entity Type:Organization
Organization Name:NORTHGATE HEALTH CLINIC, P.A.
Other - Org Name:NORTHGATE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-285-1677
Mailing Address - Street 1:600 11TH AVENUE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-1805
Mailing Address - Country:US
Mailing Address - Phone:507-285-1677
Mailing Address - Fax:507-285-0052
Practice Address - Street 1:600 11TH AVENUE NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1805
Practice Address - Country:US
Practice Address - Phone:507-285-1677
Practice Address - Fax:507-285-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2236753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03645Medicare ID - Type Unspecified