1871794578 NPI number — DAHL CHIROPRACTIC SERVICES

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 1871794578 NPI number — DAHL CHIROPRACTIC SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAHL CHIROPRACTIC SERVICES
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:
1871794578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19252
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55419-0252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-823-1702
Provider Business Mailing Address Fax Number:
612-224-9817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE GROVELAND TERRACE
Provider Second Line Business Practice Location Address:
SUITE #202
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55403-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-823-1702
Provider Business Practice Location Address Fax Number:
612-354-7577
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAHL
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-823-1702

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  2647 , 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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