Provider Demographics
NPI:1306151832
Name:NORTH STAR FAMILY CHIROPRACTIC, PC
Entity type:Organization
Organization Name:NORTH STAR FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/ CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BISCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-294-4924
Mailing Address - Street 1:8380 CITY CENTRE DRIVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-294-4924
Mailing Address - Fax:
Practice Address - Street 1:8380 CITY CENTRE DRIVE
Practice Address - Street 2:SUITE 180
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-294-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5273111N00000X
MN5277111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN350004475Medicare PIN
MN350004463Medicare PIN