Healthcare Provider Details

I. General information

NPI: 1659581049
Provider Name (Legal Business Name): FAMILY CHIROPRACTIC CENTER OF ST. PAUL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 12/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 HOWARD AVE
SAINT PAUL NE
68873-2120
US

IV. Provider business mailing address

207 HOWARD AVE.
ST. PAUL NE
68873
US

V. Phone/Fax

Practice location:
  • Phone: 308-381-2029
  • Fax:
Mailing address:
  • Phone: 308-381-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1305
License Number StateNE

VIII. Authorized Official

Name: DR. BRANDON MICHAEL TRAUDT
Title or Position: OWNER
Credential: D.C.
Phone: 308-754-5515