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General NPI Number Information
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NPI Number | 1437699790
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Entity Type | Organization
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Legal Business Name | IMPERIAL FAMILY CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 19685 PILOT KNOB RD SUITE 260
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City | FARMINGTON
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State | MN
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Zip | 55024-7238
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Country | US
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Telephone | 651-478-6988
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Fax | 651-478-6990
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Provider Business Mailing Address
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Address Line | 19685 PILOT KNOB RD SUITE 260
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City | FARMINGTON
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State | MN
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Zip | 55024-7238
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Country | US
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Telephone | 651-478-6988
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Fax | 651-478-6990
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | DR. CORY BLANCHARD
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Credential | D.C.
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Telephone | 651-478-6988
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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 | 6311
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License Number State | MN
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