Provider Demographics
NPI:1487759684
Name:CHIROPRACTIC HEALTH SERVICE PA
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH SERVICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DIBCN
Authorized Official - Phone:507-451-1654
Mailing Address - Street 1:207 W HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3959
Mailing Address - Country:US
Mailing Address - Phone:507-451-1654
Mailing Address - Fax:507-451-1655
Practice Address - Street 1:207 W HOLLY ST
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3959
Practice Address - Country:US
Practice Address - Phone:507-451-1654
Practice Address - Fax:507-451-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN23111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN35034CHOtherBLUE CROSS OFFICE NUMBER
MN35034CHOtherBLUE CROSS OFFICE NUMBER