Provider Demographics
NPI:1912195124
Name:MIDWAY CHIROPRACTIC AND HEALTH SERVICES PA
Entity type:Organization
Organization Name:MIDWAY CHIROPRACTIC AND HEALTH SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:S
Authorized Official - Last Name:LILJA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-333-0658
Mailing Address - Street 1:464 HAMLINE AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2945
Mailing Address - Country:US
Mailing Address - Phone:651-644-7207
Mailing Address - Fax:651-644-6653
Practice Address - Street 1:464 HAMLINE AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2945
Practice Address - Country:US
Practice Address - Phone:651-644-7207
Practice Address - Fax:651-644-6653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty