Healthcare Provider Details

I. General information

NPI: 1497528863
Provider Name (Legal Business Name): CORREA CHIROPRACTIC SPORT AND INJUTY REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14532 HAYES RD
APPLE VALLEY MN
55124-7450
US

IV. Provider business mailing address

14532 HAYES RD LOWER
APPLE VALLEY MN
55124-7450
US

V. Phone/Fax

Practice location:
  • Phone: 651-332-9494
  • Fax:
Mailing address:
  • Phone: 651-332-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARILY CORREA
Title or Position: OWNER
Credential: DC
Phone: 651-332-9494