Provider Demographics
NPI:1831450014
Name:SOUTH LEXINGTON CHIROPRACTIC, P.A.
Entity type:Organization
Organization Name:SOUTH LEXINGTON CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-454-6677
Mailing Address - Street 1:4250 LEXINGTON AVE S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2607
Mailing Address - Country:US
Mailing Address - Phone:651-454-6677
Mailing Address - Fax:651-454-8333
Practice Address - Street 1:4250 LEXINGTON AVE S
Practice Address - Street 2:SUITE 110
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2607
Practice Address - Country:US
Practice Address - Phone:651-454-6677
Practice Address - Fax:651-454-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3561111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty