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General NPI Number Information
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NPI Number | 1588936504
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Entity Type | Organization
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Legal Business Name | HMOOB FAMILY CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 02/07/2012
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Last Update Date | 02/07/2012
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Provider Practice Location Address
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Address Line | 995 UNIVERSITY AVE W SUITE 105
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City | SAINT PAUL
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State | MN
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Zip | 55104-4796
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Country | US
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Telephone | 651-646-8088
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Fax | 651-645-0429
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Provider Business Mailing Address
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Address Line | 995 UNIVERSITY AVE W SUITE 105
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City | SAINT PAUL
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State | MN
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Zip | 55104-4796
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Country | US
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Telephone | 651-646-8088
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Fax | 651-645-0429
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHER NOT APPLICABLE YANG
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Credential | D.C.
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Telephone | 651-646-8976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 5621
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License Number State | MN
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