Provider Demographics
NPI:1831250810
Name:AUDETTE CHIROPRACTIC CLINIC P.A.
Entity type:Organization
Organization Name:AUDETTE CHIROPRACTIC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AUDETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-624-5759
Mailing Address - Street 1:438 N 57TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-3723
Mailing Address - Country:US
Mailing Address - Phone:218-624-5759
Mailing Address - Fax:218-624-4668
Practice Address - Street 1:438 N 57TH AVE W
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-3723
Practice Address - Country:US
Practice Address - Phone:218-624-5759
Practice Address - Fax:218-624-4668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN06720AUOtherBCBS MN
MN06720AUOtherBCBS MN