Provider Demographics
NPI:1801911292
Name:ALLIE CHIROPRACTIC CLINIC, PA
Entity type:Organization
Organization Name:ALLIE CHIROPRACTIC CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-487-5334
Mailing Address - Street 1:1654 RICE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55117-3757
Mailing Address - Country:US
Mailing Address - Phone:651-487-5334
Mailing Address - Fax:651-487-7684
Practice Address - Street 1:1654 RICE ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55117-3757
Practice Address - Country:US
Practice Address - Phone:651-487-5334
Practice Address - Fax:651-487-7684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2927111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN366828200Medicaid
MN366828200Medicaid
MNU29736Medicare UPIN