Provider Demographics
NPI:1063519627
Name:METTLER FAMILY CHIROPRACTIC PA
Entity type:Organization
Organization Name:METTLER FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRATARY - TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CECIL
Authorized Official - Last Name:METTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-346-1077
Mailing Address - Street 1:105 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55975-1227
Mailing Address - Country:US
Mailing Address - Phone:507-346-1077
Mailing Address - Fax:507-346-7117
Practice Address - Street 1:105 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55975-1227
Practice Address - Country:US
Practice Address - Phone:507-346-1077
Practice Address - Fax:507-346-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1629386-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN208685900Medicaid
MN3C398MEOtherBCBS
MN3C398MEOtherBCBS