Provider Demographics
NPI:1154715340
Name:MN CHIROPRACTIC & ACUPUNCTURE, PA
Entity type:Organization
Organization Name:MN CHIROPRACTIC & ACUPUNCTURE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:XENG
Authorized Official - Middle Name:
Authorized Official - Last Name:HER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-315-5495
Mailing Address - Street 1:393 DUNLAP ST N
Mailing Address - Street 2:SUITE 725
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4200
Mailing Address - Country:US
Mailing Address - Phone:651-315-5495
Mailing Address - Fax:651-409-3733
Practice Address - Street 1:393 DUNLAP ST N
Practice Address - Street 2:SUITE 725
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4200
Practice Address - Country:US
Practice Address - Phone:651-315-5495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5542111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty