Provider Demographics
NPI:1154513489
Name:LINDEN CHIROPRACTIC CLINIC P.A.
Entity type:Organization
Organization Name:LINDEN CHIROPRACTIC CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LINDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-231-2513
Mailing Address - Street 1:1604 1ST ST S
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4243
Mailing Address - Country:US
Mailing Address - Phone:320-231-2513
Mailing Address - Fax:320-231-3135
Practice Address - Street 1:1604 1ST ST S
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4243
Practice Address - Country:US
Practice Address - Phone:320-231-2513
Practice Address - Fax:320-231-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN762528600Medicaid
MN60676LIOtherBCBS
MN350002789Medicare PIN
MNT82050Medicare UPIN
MN5880890001Medicare NSC