Provider Demographics
NPI:1154520039
Name:SOLTIS FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:SOLTIS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LYLE
Authorized Official - Last Name:SOLTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-442-9727
Mailing Address - Street 1:32 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1113
Mailing Address - Country:US
Mailing Address - Phone:952-442-9727
Mailing Address - Fax:952-442-2031
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1113
Practice Address - Country:US
Practice Address - Phone:952-442-9727
Practice Address - Fax:952-442-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN35003220Medicare PIN
MN35003221Medicare PIN