Provider Demographics
NPI:1215085964
Name:CHIROPRACTIC FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-425-9439
Mailing Address - Street 1:314 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-2372
Mailing Address - Country:US
Mailing Address - Phone:715-425-9439
Mailing Address - Fax:
Practice Address - Street 1:314 N 2ND ST
Practice Address - Street 2:
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022-2372
Practice Address - Country:US
Practice Address - Phone:715-425-9439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38962100Medicaid
WI000170115Medicare PIN
WIU76308Medicare UPIN