Provider Demographics
NPI:1831411727
Name:GENESIS CHIROPRACTIC HEALTH CENTER
Entity type:Organization
Organization Name:GENESIS CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIK
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:HAN-LINDEMYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-905-0330
Mailing Address - Street 1:4678 SLATER RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2362
Mailing Address - Country:US
Mailing Address - Phone:651-905-0330
Mailing Address - Fax:651-905-0425
Practice Address - Street 1:4678 SLATER RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2362
Practice Address - Country:US
Practice Address - Phone:651-905-0330
Practice Address - Fax:651-905-0425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4332814-00Medicaid
MN350002716Medicare PIN