1639208739 NPI number — AFFORDABLE CHIROPRACTIC CENTER, P.A.

Table of content: (NPI 1639208739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639208739 NPI number — AFFORDABLE CHIROPRACTIC CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AFFORDABLE CHIROPRACTIC CENTER, 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:
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:
1639208739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4535 HODGSON RD
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:
55126-1949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-490-1507
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4535 HODGSON RD
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:
55126-1949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-490-1507
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOHN
Authorized Official First Name:
DUANE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR OWNER
Authorized Official Telephone Number:
651-490-1507

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2834 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 126828700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350004070 . This is a "MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com