Provider Demographics
NPI:1528285475
Name:MAGNUSON CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:MAGNUSON CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-553-3175
Mailing Address - Street 1:23 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:MN
Mailing Address - Zip Code:56097-1617
Mailing Address - Country:US
Mailing Address - Phone:507-553-3175
Mailing Address - Fax:
Practice Address - Street 1:23 3RD ST SE
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:MN
Practice Address - Zip Code:56097-1617
Practice Address - Country:US
Practice Address - Phone:507-553-3175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDC3692111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN316L0MAOtherBCBS
MN316L0MAOtherBCBS