Provider Demographics
NPI:1962587121
Name:IN-LINE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:IN-LINE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAALA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-249-4900
Mailing Address - Street 1:512 2ND STREET
Mailing Address - Street 2:PO BOX 103
Mailing Address - City:MORGAN
Mailing Address - State:MN
Mailing Address - Zip Code:56266-0103
Mailing Address - Country:US
Mailing Address - Phone:507-249-4900
Mailing Address - Fax:507-249-4901
Practice Address - Street 1:512 2ND STREET
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:MN
Practice Address - Zip Code:56266-0103
Practice Address - Country:US
Practice Address - Phone:507-249-4900
Practice Address - Fax:507-249-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN264K2INOtherBCBS
MN637653300OtherMEDICAL ASSISTANCE ID
MN663931OtherCHIROCARE ID
MN264K2INOtherBCBS