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General NPI Number Information
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NPI Number | 1487983722
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC CENTER OF LITTLE FALLS, P.A.
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 01/18/2010
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Provider Practice Location Address
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Address Line | 42 E BROADWAY
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3050
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Country | US
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Telephone | 320-632-9224
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Fax | 320-632-6303
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Provider Business Mailing Address
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Address Line | 42 E BROADWAY
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City | LITTLE FALLS
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State | MN
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Zip | 56345-3050
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Country | US
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Telephone | 320-632-9224
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Fax | 320-632-6303
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Authorized Official
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Title or Position | MANAGER
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Name | KIM JOHNSON
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Credential |
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Telephone | 320-632-9224
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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 | 5196
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License Number State | MN
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