Healthcare Provider Details

I. General information

NPI: 1780876557
Provider Name (Legal Business Name): BYRON CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NW FRONTAGE RD
BYRON MN
55920
US

IV. Provider business mailing address

501 FRONTAGE RD NW
BYRON MN
55920-1275
US

V. Phone/Fax

Practice location:
  • Phone: 507-775-2711
  • Fax: 507-775-2661
Mailing address:
  • Phone: 507-775-2711
  • Fax: 507-775-2611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number002944
License Number StateMN

VIII. Authorized Official

Name: MRS. SALLY LEE MCCONAUGHEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 507-775-2771