Provider Demographics
NPI:1316127384
Name:VERDAN PA
Entity type:Organization
Organization Name:VERDAN PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR.
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DANIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-566-8023
Mailing Address - Street 1:13060 CENTRAL AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-4149
Mailing Address - Country:US
Mailing Address - Phone:763-566-8023
Mailing Address - Fax:763-566-0630
Practice Address - Street 1:13060 CENTRAL AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55434-4149
Practice Address - Country:US
Practice Address - Phone:763-566-8023
Practice Address - Fax:763-566-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty