Healthcare Provider Details

I. General information

NPI: 1841465515
Provider Name (Legal Business Name): STILLWATER FAMILY CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 N STILLWATER BLVD. N
STILLWATER MN
55082
US

IV. Provider business mailing address

6750 STILLWATER BLVD N
STILLWATER MN
55082-5485
US

V. Phone/Fax

Practice location:
  • Phone: 651-439-2004
  • Fax: 651-689-1636
Mailing address:
  • Phone: 651-439-2004
  • Fax: 651-689-1636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: BRENDA FOXHOVEN I
Title or Position: OWNER
Credential: CHIROPRACTOR
Phone: 651-439-2004