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General NPI Number Information
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NPI Number | 1205905924
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Entity Type | Organization
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Legal Business Name | GRAVON'S NATURAL CHIROPRACTIC CENTER P A
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 1024 OXFORD ST
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City | WORTHINGTON
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State | MN
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Zip | 56187-1681
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Country | US
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Telephone | 507-376-9771
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Fax | 507-376-9798
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Provider Business Mailing Address
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Address Line | PO BOX 396
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City | WORTHINGTON
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State | MN
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Zip | 56187-0396
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Country | US
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Telephone | 507-376-9771
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Fax | 507-376-9798
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Authorized Official
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Title or Position | INSURANCE MGR
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Name | MS. LORI SCHNIEDER
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Credential |
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Telephone | 507-376-9771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2237
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License Number State | MN
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