=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326092776
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC FIRST WELLNESS CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2006
-----------------------------------------------------
Last Update Date | 10/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3257 19TH ST NW SUITE 1
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-6796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-292-1800
-----------------------------------------------------
Fax | 507-292-1804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3257 19TH ST NW SUITE 1
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55901-6796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-292-1800
-----------------------------------------------------
Fax | 507-292-1804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. NICHOLAS A KRAUSE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 507-292-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4599
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------