1265508089 NPI number — ADVANCED CHIROPRACTIC OF MANKATO, PC

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 1265508089 NPI number — ADVANCED CHIROPRACTIC OF MANKATO, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CHIROPRACTIC OF MANKATO, PC
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:
1265508089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1712 JAMES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH MANKATO
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56003-1804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-385-2000
Provider Business Mailing Address Fax Number:
507-385-1933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 WEBSTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH MANKATO
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56003-2223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-385-2000
Provider Business Practice Location Address Fax Number:
507-385-1933
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAFF
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER/ VP
Authorized Official Telephone Number:
507-385-2000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3472 , 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)





Copyright © 2007-2025 www.npivalidator.com