Provider Demographics
NPI:1770682551
Name:HASS, ANTHONY BERNARD (DC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:BERNARD
Last Name:HASS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-7901
Mailing Address - Country:US
Mailing Address - Phone:320-532-3154
Mailing Address - Fax:320-532-3111
Practice Address - Street 1:375 WEST ISLE STREET
Practice Address - Street 2:
Practice Address - City:ISLE
Practice Address - State:MN
Practice Address - Zip Code:56342-2640
Practice Address - Country:US
Practice Address - Phone:320-676-3661
Practice Address - Fax:320-676-4011
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN279727500Medicaid
231223OtherCCMI
3C131HAOtherBCBS
3C131HAOtherBCBS
MN350003820Medicare ID - Type Unspecified
T70729Medicare UPIN
MN350003823Medicare ID - Type Unspecified
MN279727500Medicaid
MN350003822Medicare ID - Type Unspecified
MN350003819Medicare ID - Type Unspecified