Healthcare Provider Details

I. General information

NPI: 1093868184
Provider Name (Legal Business Name): NORTHWOODS CHIROPRACTIC OF CHISAGO CITY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11185 LAKE BLVD
CHISAGO CITY MN
55013-9817
US

IV. Provider business mailing address

11185 LAKE BLVD
CHISAGO CITY MN
55013-9817
US

V. Phone/Fax

Practice location:
  • Phone: 651-257-3914
  • Fax: 651-257-3915
Mailing address:
  • Phone: 651-257-3914
  • Fax: 651-257-3915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number002174
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003667
License Number StateMN

VIII. Authorized Official

Name: DR. CARRIE ZVONAR
Title or Position: PRESIDENT
Credential: D.C.
Phone: 651-257-3914