1396864732 NPI number — ABELER CHIROPRACTIC OF ANDOVER, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396864732 NPI number — ABELER CHIROPRACTIC OF ANDOVER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABELER CHIROPRACTIC OF ANDOVER, P.A.
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:
1396864732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2705 BUNKER LAKE BLVD NW
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55304-3784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
763-754-2500
Provider Business Mailing Address Fax Number:
763-755-3852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2705 BUNKER LAKE BLVD NW
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55304-3784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-754-2500
Provider Business Practice Location Address Fax Number:
763-755-3852
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABELER
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
763-754-2500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2048 , 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)

  • Identifier: 376327700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60G38AB . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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