Healthcare Provider Details

I. General information

NPI: 1780807883
Provider Name (Legal Business Name): CEDAR CREEK FAMILY CHIROPRACTIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 COOPER AVENUE NORTH SUITE #160
ST. CLOUD MN
56303-4446
US

IV. Provider business mailing address

203 COOPER AVENUE NORTH SUITE #160
ST. CLOUD MN
56303-4446
US

V. Phone/Fax

Practice location:
  • Phone: 320-310-4000
  • Fax: 320-253-1575
Mailing address:
  • Phone: 320-310-4000
  • Fax: 320-253-1575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4838
License Number StateMN

VIII. Authorized Official

Name: MRS. FAITH A. SCHUMANN
Title or Position: CEO
Credential: DC
Phone: 320-310-4000