Provider Demographics
NPI:1215080940
Name:CROSSROADS CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:CROSSROADS CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOLIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-252-1167
Mailing Address - Street 1:4544 COUNTY ROAD 134
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4813
Mailing Address - Country:US
Mailing Address - Phone:320-252-3711
Mailing Address - Fax:
Practice Address - Street 1:4544 COUNTY ROAD 134
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4813
Practice Address - Country:US
Practice Address - Phone:320-252-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2457111N00000X
MN2974111N00000X
MN3792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC06516Medicare ID - Type Unspecified