Provider Demographics
NPI:1215428271
Name:MENDAKOTA CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:MENDAKOTA CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-452-8333
Mailing Address - Street 1:776 HIGHWAY 110
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1509
Mailing Address - Country:US
Mailing Address - Phone:651-452-8333
Mailing Address - Fax:651-452-0387
Practice Address - Street 1:776 NORTH PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120
Practice Address - Country:US
Practice Address - Phone:651-452-8333
Practice Address - Fax:651-452-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty