Provider Demographics
NPI:1063546224
Name:FAMILY FRIENDLY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:FAMILY FRIENDLY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ENGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-767-7499
Mailing Address - Street 1:1557 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4799
Mailing Address - Country:US
Mailing Address - Phone:763-767-7499
Mailing Address - Fax:763-767-7517
Practice Address - Street 1:1557 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4799
Practice Address - Country:US
Practice Address - Phone:763-767-7499
Practice Address - Fax:763-767-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3648111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231227100Medicaid
MN231227100Medicaid
MN350001876Medicare ID - Type Unspecified