Healthcare Provider Details

I. General information

NPI: 1720219447
Provider Name (Legal Business Name): PLUM CREEK CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24875 PANAMA AVE
ELKO MN
55020-9485
US

IV. Provider business mailing address

24875 PANAMA AVE
ELKO MN
55020-9485
US

V. Phone/Fax

Practice location:
  • Phone: 952-461-3675
  • Fax: 952-461-3675
Mailing address:
  • Phone: 952-461-3675
  • Fax: 952-461-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4362
License Number StateMN

VIII. Authorized Official

Name: DR. CYNTHIA SHEPARD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 952-461-3675