Provider Demographics
NPI:1124349253
Name:WASECA FAMILY CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:WASECA FAMILY CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DASCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-835-7660
Mailing Address - Street 1:117 STATE ST N
Mailing Address - Street 2:
Mailing Address - City:WASECA
Mailing Address - State:MN
Mailing Address - Zip Code:56093-2928
Mailing Address - Country:US
Mailing Address - Phone:507-835-7660
Mailing Address - Fax:507-835-7691
Practice Address - Street 1:117 STATE ST N
Practice Address - Street 2:
Practice Address - City:WASECA
Practice Address - State:MN
Practice Address - Zip Code:56093-2928
Practice Address - Country:US
Practice Address - Phone:507-835-7660
Practice Address - Fax:507-835-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3328261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN343218100Medicaid
1386638161OtherINDIVIDUAL NPI
1386638161OtherINDIVIDUAL NPI