1184808636 NPI number — ADVANCED CHIROPRACTIC & WELLNESS CLINIC

Table of content: MAI YOUSIF ELTIGANI ELHADI MD (NPI 1811622962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184808636 NPI number — ADVANCED CHIROPRACTIC & WELLNESS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CHIROPRACTIC & WELLNESS CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184808636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3434 LEXINGTON AVE N STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHOREVIEW
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55126-8091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-484-0151
Provider Business Mailing Address Fax Number:
651-486-0697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3434 LEXINGTON AVE N STE 900
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHOREVIEW
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55126-8090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-484-0151
Provider Business Practice Location Address Fax Number:
651-486-0697
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOST
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
651-484-0151

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  612 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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