Provider Demographics
NPI:1487870648
Name:BARNESVILLE CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:BARNESVILLE CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-354-2148
Mailing Address - Street 1:423 FRONT ST NORTH
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56514
Mailing Address - Country:US
Mailing Address - Phone:218-354-2148
Mailing Address - Fax:218-354-2168
Practice Address - Street 1:423 FRONT ST N
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56514
Practice Address - Country:US
Practice Address - Phone:218-354-2148
Practice Address - Fax:218-354-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003260111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350001836Medicare ID - Type Unspecified