Healthcare Provider Details

I. General information

NPI: 1497872360
Provider Name (Legal Business Name): STONEBROOK FAMILY CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN STREET SUITE 103
NEW MARKET MN
55054
US

IV. Provider business mailing address

PO BOX 105
NEW MARKET MN
55054-0105
US

V. Phone/Fax

Practice location:
  • Phone: 952-461-6336
  • Fax:
Mailing address:
  • Phone: 952-461-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number711
License Number StateMN

VIII. Authorized Official

Name: DR. AARON RUDE
Title or Position: CHIEF MANAGER
Credential: DC
Phone: 952-461-6336