Provider Demographics
NPI:1538233101
Name:DOWNTOWN CHIROPRACTIC LTD.
Entity type:Organization
Organization Name:DOWNTOWN CHIROPRACTIC LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:OTTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-388-3212
Mailing Address - Street 1:212 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-2219
Mailing Address - Country:US
Mailing Address - Phone:651-388-3212
Mailing Address - Fax:651-385-0255
Practice Address - Street 1:212 FULTON ST
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-2219
Practice Address - Country:US
Practice Address - Phone:651-388-3212
Practice Address - Fax:651-385-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN188111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31144DOOtherBCBS GROUP NUMBER
MN31144DOOtherBCBS GROUP NUMBER
MNT39797Medicare UPIN
MNCO1343Medicare ID - Type UnspecifiedGROUP NUMBER