Provider Demographics
NPI:1194085035
Name:UNIVERSAL CHIROPRACTIC HEALTH CLINIC, P.A.
Entity type:Organization
Organization Name:UNIVERSAL CHIROPRACTIC HEALTH CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIRAK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAILU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-343-8885
Mailing Address - Street 1:671 SNELLING AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-1839
Mailing Address - Country:US
Mailing Address - Phone:651-647-9100
Mailing Address - Fax:651-641-0450
Practice Address - Street 1:3463 MINNEHAHA AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-2624
Practice Address - Country:US
Practice Address - Phone:612-334-8885
Practice Address - Fax:651-641-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350003864Medicare UPIN