MEDICARE: LOWRY FAMILY CHIROPRACTIC CLINIC, PA

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	4209	MN

General Provider Information

NPI Number	:	1891979555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOWRY FAMILY CHIROPRACTIC CLINIC, PA

Provider Business Mailing Address
First Line	:	4149 LYNDALE AVE N
Second Line	:	SUITE 200
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-1703
Country	:	US
Telephone Number	:	612-521-2261
Fax Number	:	612-521-5200

Provider Business Practice Location Address
First Line	:	4149 LYNDALE AVE N
Second Line	:	SUITE 200
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55412-1703
Country	:	US
Telephone Number	:	612-521-2261
Fax Number	:	612-521-5200

Authorized Official
Title or Position	:	PRESIDEN
Name	:	BRYAN HUTCHISON
Credential	:	D.C.
Telephone Number	:	612-521-2261

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	12/18/2007

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