Provider Demographics
NPI:1215120373
Name:FLIKKE CHIROPRACTIC PA
Entity type:Organization
Organization Name:FLIKKE CHIROPRACTIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:FLIKKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-707-0110
Mailing Address - Street 1:200 E TRAVELERS TRAIL
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337
Mailing Address - Country:US
Mailing Address - Phone:952-707-0110
Mailing Address - Fax:952-707-0115
Practice Address - Street 1:200 E TRAVELERS TRAIL
Practice Address - Street 2:SUITE 105
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-707-0110
Practice Address - Fax:952-707-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4440111N00000X
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN255KOFLOtherBCBS
MN254K9SOOtherBCBS
MN254K9SOOtherBCBS
MNCO3416Medicare PIN