Healthcare Provider Details

I. General information

NPI: 1437310711
Provider Name (Legal Business Name): ACORN CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1746 LINCOLN AVE
SAINT PAUL MN
55105-1953
US

IV. Provider business mailing address

1746 LINCOLN AVE
SAINT PAUL MN
55105-1953
US

V. Phone/Fax

Practice location:
  • Phone: 651-260-1763
  • Fax:
Mailing address:
  • Phone: 651-260-1763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number4395
License Number StateMN

VIII. Authorized Official

Name: DR. VIRGINIA PETRY DUNIVAN
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 651-260-1763