Healthcare Provider Details

I. General information

NPI: 1821074089
Provider Name (Legal Business Name): RICH PRAIRIE CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MAIN ST N
PIERZ MN
56364-1517
US

IV. Provider business mailing address

232 MAIN ST N PO BOX 339
PIERZ MN
56364-1517
US

V. Phone/Fax

Practice location:
  • Phone: 320-468-2221
  • Fax:
Mailing address:
  • Phone: 320-468-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMN002959
License Number StateMN

VIII. Authorized Official

Name: MR. HERBERT JOSEPH JUETTEN
Title or Position: OWNER OPERATOR CEO
Credential: DC
Phone: 320-468-2221