Healthcare Provider Details

I. General information

NPI: 1164592507
Provider Name (Legal Business Name): LIEFFRING CHIROPRACTIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 14TH ST STE C
CLOQUET MN
55720-3703
US

IV. Provider business mailing address

1219 14TH ST STE C
CLOQUET MN
55720-3703
US

V. Phone/Fax

Practice location:
  • Phone: 218-878-0895
  • Fax: 218-485-8941
Mailing address:
  • Phone: 218-878-0895
  • Fax: 218-485-8941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1532
License Number StateMN

VIII. Authorized Official

Name: DR. MARK JOSEPH LIEFFRING
Title or Position: PRESIDENT
Credential: D.C.
Phone: 218-485-8688