MEDICARE: GODFREY CHIROPRACTIC CLINIC INC

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	1436	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679615090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GODFREY CHIROPRACTIC CLINIC INC

Provider Business Mailing Address
First Line	:	119 6TH AVE E
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-1801
Country	:	US
Telephone Number	:	320-762-8185
Fax Number	:	320-762-8186

Provider Business Practice Location Address
First Line	:	119 6TH AVE E
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-1801
Country	:	US
Telephone Number	:	320-762-8185
Fax Number	:	320-762-8186

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	HEIDI BAYER
Credential	:
Telephone Number	:	320-762-8185

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	02/18/2015

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Directions to “GODFREY CHIROPRACTIC CLINIC INC ” Practice Location

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