Provider Demographics
NPI:1972680940
Name:VALLEY WEST CHIROPRACTIC CLINIC, LTD.
Entity type:Organization
Organization Name:VALLEY WEST CHIROPRACTIC CLINIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERYN
Authorized Official - Middle Name:
Authorized Official - Last Name:STENNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-888-5805
Mailing Address - Street 1:10700 NORMANDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2700
Mailing Address - Country:US
Mailing Address - Phone:952-888-5805
Mailing Address - Fax:952-888-7563
Practice Address - Street 1:10700 NORMANDALE BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55437-2700
Practice Address - Country:US
Practice Address - Phone:952-888-5805
Practice Address - Fax:952-888-7563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC01105Medicare ID - Type UnspecifiedCHIROPRACTOR