MEDICARE: FAMILY WEST CHIROPRACTIC PA.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3165	MN

General Provider Information

NPI Number	:	1114104759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY WEST CHIROPRACTIC PA.

Provider Business Mailing Address
First Line	:	8800 W. HWY 7 STE. 222
Second Line	:
City	:	ST. LOUIS PARK
State	:	MN
Zip	:	55426-3927
Country	:	US
Telephone Number	:	952-938-3334
Fax Number	:

Provider Business Practice Location Address
First Line	:	8800 HIGHWAY 7 STE 222
Second Line	:
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-3927
Country	:	US
Telephone Number	:	952-938-3334
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ALLEN HEPFNER
Credential	:
Telephone Number	:	952-938-3334

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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