Organization
UNITED CHIROPRACTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN H. PHAM DC, DAAPM, DACBN (DIRECTOR)
(651) 642-1110
Entity
Organization
Contact information
Practice address
995 UNIVERSITY AVE W, SUITE 101, SAINT PAUL, MN 55104-4796
(651) 642-1110
(651) 642-1113
Mailing address
995 UNIVERSITY AVE W, SUITE 101, SAINT PAUL, MN 55104-4796
(651) 642-1110
(651) 642-1113
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
Primary
3532
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
232018
ACN
MN
01
—
5C969PH
BCBS-MN
MN
Enumeration date
02/28/2007
Last updated
08/22/2020
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