1588842009 NPI number — CHIROPRACTIC ASSOCIATES OF NORTHERN MINNESOTA, LTD.

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 1588842009 NPI number — CHIROPRACTIC ASSOCIATES OF NORTHERN MINNESOTA, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC ASSOCIATES OF NORTHERN MINNESOTA, LTD.
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:
6
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:
1588842009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 PAINE FARM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55804-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-722-9300
Provider Business Mailing Address Fax Number:
218-722-9415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 MILLER TRUNK HWY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55811-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-722-9300
Provider Business Practice Location Address Fax Number:
218-722-9415
Provider Enumeration Date:
02/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LESAVAGE
Authorized Official First Name:
GRAF
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
218-722-9300

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1539 , 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: 52485LE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com