Healthcare Provider Details

I. General information

NPI: 1912169087
Provider Name (Legal Business Name): AFTON CHIROPRACTIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SAINT CROIX TRL S SUITE 200
LAKELAND MN
55043-8404
US

IV. Provider business mailing address

44 SAINT CROIX TRL S SUITE 200
LAKELAND MN
55043-8404
US

V. Phone/Fax

Practice location:
  • Phone: 651-436-7757
  • Fax: 651-436-6381
Mailing address:
  • Phone: 651-436-7757
  • Fax: 651-436-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JODIE L EIAN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 651-436-7757