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General NPI Number Information
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NPI Number | 1396063459
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Entity Type | Organization
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Legal Business Name | HMONG CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 616 RICE ST SUITE B
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City | SAINT PAUL
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State | MN
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Zip | 55103-1827
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Country | US
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Telephone | 651-210-9657
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Fax |
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Provider Business Mailing Address
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Address Line | 616 RICE ST SUITE B
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City | SAINT PAUL
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State | MN
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Zip | 55103-1827
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Country | US
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Telephone | 651-210-9657
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BLONG BLIAXA VANG
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Credential | D.C.
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Telephone | 651-210-9657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 4471
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License Number State | MN
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