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General NPI Number Information
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NPI Number | 1841704566
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Entity Type | Organization
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Legal Business Name | CONNECTED FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 11/17/2017
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Last Update Date | 11/17/2017
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Provider Practice Location Address
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Address Line | 306 MAIN ST STE 101
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City | LA CRESCENT
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State | MN
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Zip | 55947-1828
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Country | US
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Telephone | 507-895-8100
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Fax | 608-268-9710
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Provider Business Mailing Address
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Address Line | 306 MAIN ST STE 101
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City | LA CRESCENT
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State | MN
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Zip | 55947-1828
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Country | US
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Telephone | 507-895-8100
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Fax | 608-268-9710
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | DR. KASEY MARIE PAYNE
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Credential | DC
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Telephone | 507-895-8100
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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 | 5865
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License Number State | MN
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