Provider Demographics
NPI:1386922250
Name:MAIRS CHIROPRACTIC INC
Entity type:Organization
Organization Name:MAIRS CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:MAIRS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-845-8536
Mailing Address - Street 1:104 22ND AVE NE STE 1
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2641
Mailing Address - Country:US
Mailing Address - Phone:507-835-1600
Mailing Address - Fax:507-835-1609
Practice Address - Street 1:104 22ND AVE NE STE 1
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2641
Practice Address - Country:US
Practice Address - Phone:507-835-1600
Practice Address - Fax:507-835-1609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU73237Medicare UPIN