Healthcare Provider Details

I. General information

NPI: 1376757682
Provider Name (Legal Business Name): CHIROPRACTIC HEALTH CENTER P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 E SUPERIOR ST STE 112
DULUTH MN
55802-2253
US

IV. Provider business mailing address

925 E SUPERIOR ST STE 112
DULUTH MN
55802-2253
US

V. Phone/Fax

Practice location:
  • Phone: 218-628-0646
  • Fax: 218-628-1889
Mailing address:
  • Phone: 218-628-0646
  • Fax: 218-628-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: COREY MILBRANDT
Title or Position: CFO
Credential: DC
Phone: 218-628-0646