Provider Demographics
NPI:1669281341
Name:CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-660-7887
Mailing Address - Street 1:16283 IPAVA AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-4658
Mailing Address - Country:US
Mailing Address - Phone:952-898-2287
Mailing Address - Fax:952-898-3287
Practice Address - Street 1:16283 IPAVA AVE
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-4658
Practice Address - Country:US
Practice Address - Phone:952-898-2287
Practice Address - Fax:952-898-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty