MEDICARE: PRAIRIE CHIROPRACTIC

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	5403	MN

General Provider Information

NPI Number	:	1972810158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAIRIE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	134 HIGHWAY 68
Second Line	:
City	:	WABASSO
State	:	MN
Zip	:	56293
Country	:	US
Telephone Number	:	507-342-2004
Fax Number	:	507-342-2005

Provider Business Practice Location Address
First Line	:	134 HIGHWAY 68
Second Line	:
City	:	WABASSO
State	:	MN
Zip	:	56293
Country	:	US
Telephone Number	:	507-342-2004
Fax Number	:	507-342-2005

Authorized Official
Title or Position	:	OWNER
Name	:	ANN BENEDICT
Credential	:	D.C.
Telephone Number	:	507-342-2004

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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Directions to “PRAIRIE CHIROPRACTIC ” Practice Location

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