Provider Demographics
NPI:1487983722
Name:FAMILY CHIROPRACTIC CENTER OF LITTLE FALLS, P.A.
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF LITTLE FALLS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-632-9224
Mailing Address - Street 1:42 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3050
Mailing Address - Country:US
Mailing Address - Phone:320-632-9224
Mailing Address - Fax:320-632-6303
Practice Address - Street 1:42 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3050
Practice Address - Country:US
Practice Address - Phone:320-632-9224
Practice Address - Fax:320-632-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty