Provider Demographics
NPI:1912055435
Name:ANOKA CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:ANOKA CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARNES
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-421-1410
Mailing Address - Street 1:646 E RIVER RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1884
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:646 E RIVER RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1884
Practice Address - Country:US
Practice Address - Phone:763-421-1410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN52060BAOtherBLUE CROSS BLUE SHIELD
MNT39465Medicare UPIN
MNCO1493Medicare ID - Type Unspecified