Healthcare Provider Details

I. General information

NPI: 1396063459
Provider Name (Legal Business Name): HMONG CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 RICE ST SUITE B
SAINT PAUL MN
55103-1827
US

IV. Provider business mailing address

616 RICE ST SUITE B
SAINT PAUL MN
55103-1827
US

V. Phone/Fax

Practice location:
  • Phone: 651-210-9657
  • Fax:
Mailing address:
  • Phone: 651-210-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number4471
License Number StateMN

VIII. Authorized Official

Name: DR. BLONG BLIAXA VANG
Title or Position: OWNER
Credential: D.C.
Phone: 651-210-9657