Healthcare Provider Details

I. General information

NPI: 1679615090
Provider Name (Legal Business Name): GODFREY CHIROPRACTIC CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 6TH AVE E
ALEXANDRIA MN
56308-1801
US

IV. Provider business mailing address

119 6TH AVE E
ALEXANDRIA MN
56308-1801
US

V. Phone/Fax

Practice location:
  • Phone: 320-762-8185
  • Fax: 320-762-8186
Mailing address:
  • Phone: 320-762-8185
  • Fax: 320-762-8186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1436
License Number StateMN

VIII. Authorized Official

Name: HEIDI BAYER
Title or Position: OFFICE MANAGER
Credential:
Phone: 320-762-8185