MEDICARE: CHIROPRACTIC HEALTH SERVICE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	23	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35034CH	OTHER	MN	BLUE CROSS OFFICE NUMBER

General Provider Information

NPI Number	:	1487759684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC HEALTH SERVICE PA

Provider Business Mailing Address
First Line	:	207 W HOLLY ST
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-3959
Country	:	US
Telephone Number	:	507-451-1654
Fax Number	:	507-451-1655

Provider Business Practice Location Address
First Line	:	207 W HOLLY ST
Second Line	:
City	:	OWATONNA
State	:	MN
Zip	:	55060-3959
Country	:	US
Telephone Number	:	507-451-1654
Fax Number	:	507-451-1655

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LYLE CHARLES COLEMAN
Credential	:	D.C., DIBCN
Telephone Number	:	507-451-1654

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	04/07/2010

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