Basic Information
| Provider Information | |||||||||
| NPI: | 1770682551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASS | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | BERNARD | ||||||||
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| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 ELM ST N | ||||||||
| Address2: | |||||||||
| City: | ONAMIA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563597901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3205323154 | ||||||||
| FaxNumber: | 3205323111 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 WEST ISLE STREET | ||||||||
| Address2: | |||||||||
| City: | ISLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563422640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206763661 | ||||||||
| FaxNumber: | 3206764011 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 09/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 2280 | MN | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 279727500 | 05 | MN | MEDICAID | 231223 | 01 | CCMI | OTHER | 3C131HA | 01 | BCBS | OTHER |