Provider Demographics
NPI:1932325578
Name:VALLEY CHIROPRACTIC CLINIC, LTD
Entity Type:Organization
Organization Name:VALLEY CHIROPRACTIC CLINIC, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-730-7302
Mailing Address - Street 1:7975 AFTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-1544
Mailing Address - Country:US
Mailing Address - Phone:651-730-7302
Mailing Address - Fax:651-730-9671
Practice Address - Street 1:7975 AFTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-1544
Practice Address - Country:US
Practice Address - Phone:651-730-7302
Practice Address - Fax:651-730-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6C218VAOtherBCBS
MNC02413Medicare ID - Type UnspecifiedMEDICARE