Healthcare Provider Details

I. General information

NPI: 1962738443
Provider Name (Legal Business Name): FAMILY FIRST CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12203 ABERDEEN ST NE SUITE 100
BLAINE MN
55449-5174
US

IV. Provider business mailing address

12203 ABERDEEN ST NE SUITE 100
BLAINE MN
55449-5174
US

V. Phone/Fax

Practice location:
  • Phone: 763-785-4120
  • Fax: 763-785-4172
Mailing address:
  • Phone: 763-785-4120
  • Fax: 763-785-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5158
License Number StateMN

VIII. Authorized Official

Name: DR. NICHOLE APRIL RAKOW
Title or Position: OWNER
Credential: D.C.
Phone: 763-785-4120