MEDICARE: RAINY LAKE CHIROPRACTIC CLINIC, 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	3326	MN

General Provider Information

NPI Number	:	1851478242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAINY LAKE CHIROPRACTIC CLINIC, P.A.

Provider Business Mailing Address
First Line	:	501 3RD ST
Second Line	:	SUITE 100
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2305
Country	:	US
Telephone Number	:	218-283-2192
Fax Number	:	218-283-2392

Provider Business Practice Location Address
First Line	:	501 3RD ST
Second Line	:	SUITE 100
City	:	INTERNATIONAL FALLS
State	:	MN
Zip	:	56649-2305
Country	:	US
Telephone Number	:	218-283-2192
Fax Number	:	218-283-2392

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEAN CHRISTOPHER COWMAN
Credential	:	D.C.
Telephone Number	:	218-283-2192

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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