Healthcare Provider Details

I. General information

NPI: 1306040381
Provider Name (Legal Business Name): AFTON CHIROPRACTIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/05/2013
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:
Mailing address:
  • Phone: 651-436-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: TAMIE Q CAULDER
Title or Position: PRESIDENT
Credential: D.C.
Phone: 651-436-7757