Provider Demographics
NPI:1699321638
Name:PIVOTAL CHIROPRACTIC & WELLNESS PLLC
Entity type:Organization
Organization Name:PIVOTAL CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUCKER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-401-2650
Mailing Address - Street 1:1600 MADISON AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5470
Mailing Address - Country:US
Mailing Address - Phone:507-401-2650
Mailing Address - Fax:507-403-2650
Practice Address - Street 1:1600 MADISON AVE STE 112
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5470
Practice Address - Country:US
Practice Address - Phone:507-401-2650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-15
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty