Provider Demographics
NPI:1306084314
Name:SPRING GROVE FAMILY CHIROPRACTIC, PA
Entity type:Organization
Organization Name:SPRING GROVE FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-281-4894
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974
Mailing Address - Country:US
Mailing Address - Phone:612-281-4894
Mailing Address - Fax:
Practice Address - Street 1:102 1ST ST SE
Practice Address - Street 2:
Practice Address - City:SPRING GROVE
Practice Address - State:MN
Practice Address - Zip Code:55974
Practice Address - Country:US
Practice Address - Phone:612-281-4894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4774111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty