MEDICARE: NORTHSTONE FAMILY CHIROPRACTIC P.A.

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	5593	MN

General Provider Information

NPI Number	:	1194073346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHSTONE FAMILY CHIROPRACTIC P.A.

Provider Business Mailing Address
First Line	:	6041 MAIN ST STE E
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6595
Country	:	US
Telephone Number	:	651-674-5040
Fax Number	:	651-674-5070

Provider Business Practice Location Address
First Line	:	6041 MAIN ST STE E
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-6595
Country	:	US
Telephone Number	:	763-232-0326
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. KATHRYN JO DEVRIES
Credential	:	D.C.
Telephone Number	:	763-232-0326

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	01/29/2013

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