Provider Demographics
NPI:1811177546
Name:CHIROPRACTIC SERVICS LTD.
Entity type:Organization
Organization Name:CHIROPRACTIC SERVICS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:THATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-484-8448
Mailing Address - Street 1:1050 COUNTY ROAD E W
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8062
Mailing Address - Country:US
Mailing Address - Phone:651-484-8448
Mailing Address - Fax:
Practice Address - Street 1:1050 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8062
Practice Address - Country:US
Practice Address - Phone:651-484-8448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN62111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1B21367CHOtherBLUE CROSS BLUE SHIELD
1366581027OtherINDIVIDUAL NPI
MN85825100Medicaid
1B21367CHOtherBLUE CROSS BLUE SHIELD
MNTR2125Medicare UPIN