Healthcare Provider Details

I. General information

NPI: 1174759476
Provider Name (Legal Business Name): KOFORD CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OAK ST
DANUBE MN
56230
US

IV. Provider business mailing address

PO BOX 185
DANUBE MN
56230-0185
US

V. Phone/Fax

Practice location:
  • Phone: 320-823-2320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEANN KOFORD
Title or Position: OWNER
Credential:
Phone: 320-826-2320