Provider Demographics
NPI:1891154720
Name:DAHL CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:DAHL CHIROPRACTIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-497-6943
Mailing Address - Street 1:2052 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1650
Mailing Address - Country:US
Mailing Address - Phone:715-497-6943
Mailing Address - Fax:
Practice Address - Street 1:2052 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1650
Practice Address - Country:US
Practice Address - Phone:715-497-6943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-20
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5519111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty