MEDICARE: FULFILLED FAMILY CHIROPRACTIC PLLC

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

General Provider Information

NPI Number	:	1124649108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FULFILLED FAMILY CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	21427 COUNTY 7
Second Line	:
City	:	PARK RAPIDS
State	:	MN
Zip	:	56470-5286
Country	:	US
Telephone Number	:	218-839-4262
Fax Number	:

Provider Business Practice Location Address
First Line	:	21427 COUNTY 7
Second Line	:
City	:	PARK RAPIDS
State	:	MN
Zip	:	56470-5286
Country	:	US
Telephone Number	:	218-839-4262
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. HANNAH M JANZEN-QUADE
Credential	:	DC
Telephone Number	:	218-839-4262

Provider Enumeration Date	:	05/01/2020
Last Update Date	:	09/06/2022

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