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General NPI Number Information
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NPI Number | 1962549089
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Entity Type | Organization
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Legal Business Name | FAMILY WELLNESS CHIROPRACTIC, PC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 9600 28TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55441-3210
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Country | US
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Telephone | 763-546-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 9600 28TH AVE N
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City | PLYMOUTH
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State | MN
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Zip | 55441-3210
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Country | US
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Telephone | 763-546-4414
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. LORIE E PALOKANGAS
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Credential | D.C.
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Telephone | 612-735-9971
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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 | 4560
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License Number State | MN
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