Provider Demographics
NPI:1871794578
Name:DAHL CHIROPRACTIC SERVICES
Entity type:Organization
Organization Name:DAHL CHIROPRACTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-823-1702
Mailing Address - Street 1:PO BOX 19252
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-0252
Mailing Address - Country:US
Mailing Address - Phone:612-823-1702
Mailing Address - Fax:612-224-9817
Practice Address - Street 1:ONE GROVELAND TERRACE
Practice Address - Street 2:SUITE #202
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1174
Practice Address - Country:US
Practice Address - Phone:612-823-1702
Practice Address - Fax:612-354-7577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2647261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU09715Medicare UPIN
MN350001581Medicare ID - Type Unspecified