Healthcare Provider Details

I. General information

NPI: 1013101534
Provider Name (Legal Business Name): ABEL CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 WINNETKA AVE N
CRYSTAL MN
55427-2020
US

IV. Provider business mailing address

3411 WINNETKA AVE N
CRYSTAL MN
55427-2020
US

V. Phone/Fax

Practice location:
  • Phone: 763-593-1860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1205
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number404
License Number StateMN

VIII. Authorized Official

Name: DR. LEONARD JOSEPH ABEL
Title or Position: OWNER
Credential: D.C.
Phone: 763-593-1860