Provider Demographics
NPI:1548483050
Name:ARBOR LAKES CHIROPRACTIC CENTER P.A.
Entity type:Organization
Organization Name:ARBOR LAKES CHIROPRACTIC CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-494-4311
Mailing Address - Street 1:7835 MAIN ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7071
Mailing Address - Country:US
Mailing Address - Phone:763-494-4311
Mailing Address - Fax:763-494-0325
Practice Address - Street 1:7835 MAIN ST
Practice Address - Street 2:SUITE 230
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7071
Practice Address - Country:US
Practice Address - Phone:763-494-4311
Practice Address - Fax:763-494-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3681111N00000X
MN3181111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN35003213Medicare ID - Type UnspecifiedCHIROPRACTIC