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General NPI Number Information
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NPI Number | 1306040381
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Entity Type | Organization
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Legal Business Name | AFTON CHIROPRACTIC CLINIC PA
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 44 SAINT CROIX TRL S SUITE 200
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City | LAKELAND
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State | MN
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Zip | 55043-8404
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Country | US
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Telephone | 651-436-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 44 SAINT CROIX TRL S SUITE 200
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City | LAKELAND
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State | MN
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Zip | 55043-8404
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Country | US
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Telephone | 651-436-7757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMIE Q CAULDER
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Credential | D.C.
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Telephone | 651-436-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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