1346594223 NPI number — FAMILY CHIROPRACTIC OFFICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346594223 NPI number — FAMILY CHIROPRACTIC OFFICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CHIROPRACTIC OFFICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346594223
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINNEBAGO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56098-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-893-4412
Provider Business Mailing Address Fax Number:
507-893-4912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 1ST AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINNEBAGO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56098-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-893-4412
Provider Business Practice Location Address Fax Number:
507-893-4912
Provider Enumeration Date:
10/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ARNDT
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
507-893-4412

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1610 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 401527400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com