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General NPI Number Information
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NPI Number | 1942563978
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Entity Type | Organization
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Legal Business Name | WINNEBAGO CHIROPRACTIC CLINIC, INC.
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 02/13/2017
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Provider Practice Location Address
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Address Line | 115 1ST AVE NW
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City | WINNEBAGO
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State | MN
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Zip | 56098-1015
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Country | US
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Telephone | 507-893-4412
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Fax | 507-893-4912
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Provider Business Mailing Address
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Address Line | 115 1ST AVE NW PO BOX 296
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City | WINNEBAGO
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State | MN
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Zip | 56098-1015
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Country | US
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Telephone | 507-893-4412
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Fax | 507-893-4912
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHASTEN JON FENGER
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Credential | DC
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Telephone | 507-893-4412
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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 | 5655
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License Number State | MN
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