MEDICARE: MEDELBERG FAMILY CHIROPRACTIC, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3062	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366600629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDELBERG FAMILY CHIROPRACTIC, P.A.

Provider Business Mailing Address
First Line	:	710 COUNTY ROAD 75
Second Line	:	SUITE 103
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-8648
Country	:	US
Telephone Number	:	320-271-1800
Fax Number	:	320-271-1808

Provider Business Practice Location Address
First Line	:	710 COUNTY ROAD 75
Second Line	:	SUITE 103
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-8648
Country	:	US
Telephone Number	:	320-271-1800
Fax Number	:	320-271-1808

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERIC JOSEPH MEDELBERG
Credential	:	D.C.
Telephone Number	:	320-271-1800

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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