Organization
DEHAVEN CHIROPRACTIC CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RENEE K DEHAVEN (OFFICE MANAGER)
(651) 429-3015
Entity
Organization
Contact information
Practice address
4505 WHITE BEAR PKWY STE 2200, WHITE BEAR LAKE, MN 55110-3699
(651) 429-3015
Mailing address
20681 JULY AVE N, FOREST LAKE, MN 55025-9173
(651) 429-3015
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2585
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
59969-DE
BCBS
MN
Enumeration date
05/05/2009
Last updated
03/13/2023
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