# UNITED CHIROPRACTIC CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740318146
- **Authorized official:** DR. SUSAN H. PHAM DC, DAAPM, DACBN (DIRECTOR)
- **Authorized official phone:** (651) 642-1110

## Contact information

- **Practice address:** 995 UNIVERSITY AVE W, SUITE 101, SAINT PAUL, MN 55104-4796
- **Practice address phone:** (651) 642-1110
- **Practice address fax:** (651) 642-1113
- **Mailing address:** 995 UNIVERSITY AVE W, SUITE 101, SAINT PAUL, MN 55104-4796
- **Mailing address phone:** (651) 642-1110
- **Mailing address fax:** (651) 642-1113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NN1001X | Nutrition Chiropractor | 3532 | MN | Yes |

## Other

- **Enumeration date:** 02/28/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 232018 | ACN | MN |
| 01 | — | 5C969PH | BCBS-MN | MN |