Provider Demographics
NPI:1053591586
Name:HMONG CHIROPRACTIC CLINIC, PLLC
Entity type:Organization
Organization Name:HMONG CHIROPRACTIC CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BLONG
Authorized Official - Middle Name:BLIAXA
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-222-2772
Mailing Address - Street 1:616 RICE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-1827
Mailing Address - Country:US
Mailing Address - Phone:651-222-2772
Mailing Address - Fax:651-222-2829
Practice Address - Street 1:616 RICE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1827
Practice Address - Country:US
Practice Address - Phone:651-222-2772
Practice Address - Fax:651-222-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4471261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care