Provider Demographics
NPI:1538215462
Name:VIRGA CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:VIRGA CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-257-1000
Mailing Address - Street 1:12670 LAKE BLVD PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-0482
Mailing Address - Country:US
Mailing Address - Phone:651-257-1000
Mailing Address - Fax:651-257-1020
Practice Address - Street 1:12670 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-0482
Practice Address - Country:US
Practice Address - Phone:651-257-1000
Practice Address - Fax:651-257-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2686111N00000X
MN2700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN202790900Medicaid
V19848Medicare UPIN
V116002Medicare UPIN
MN3500011637Medicare ID - Type Unspecified
MN202790900Medicaid