Provider Demographics
NPI:1306874425
Name:CHIROPRACTIC UP NORTH, INC.
Entity type:Organization
Organization Name:CHIROPRACTIC UP NORTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:ROUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-283-9000
Mailing Address - Street 1:2205 2ND AVE. WEST
Mailing Address - Street 2:
Mailing Address - City:INT'L. FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-3933
Mailing Address - Country:US
Mailing Address - Phone:218-283-9000
Mailing Address - Fax:218-283-9002
Practice Address - Street 1:2205 2ND AVE. WEST
Practice Address - Street 2:
Practice Address - City:INT'L. FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-3933
Practice Address - Country:US
Practice Address - Phone:218-283-9000
Practice Address - Fax:218-283-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty