Healthcare Provider Details

I. General information

NPI: 1740816941
Provider Name (Legal Business Name): ST RAPHAELS CHIROPRACTIC CARE CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTRAL AVE N STE C
MILACA MN
56353-1571
US

IV. Provider business mailing address

120 CENTRAL AVE N STE C
MILACA MN
56353-1571
US

V. Phone/Fax

Practice location:
  • Phone: 320-362-7900
  • Fax:
Mailing address:
  • Phone: 320-362-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. KIP SMITH
Title or Position: OWNER
Credential:
Phone: 507-261-7202