Provider Demographics
NPI:1194073346
Name:NORTHSTONE FAMILY CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:NORTHSTONE FAMILY CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DEVRIES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-232-0326
Mailing Address - Street 1:6041 MAIN ST STE E
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6595
Mailing Address - Country:US
Mailing Address - Phone:651-674-5040
Mailing Address - Fax:651-674-5070
Practice Address - Street 1:6041 MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6595
Practice Address - Country:US
Practice Address - Phone:763-232-0326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty