Provider Demographics
NPI:1851478242
Name:RAINY LAKE CHIROPRACTIC CLINIC, P.A.
Entity type:Organization
Organization Name:RAINY LAKE CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:COWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-283-2192
Mailing Address - Street 1:501 3RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-2305
Mailing Address - Country:US
Mailing Address - Phone:218-283-2192
Mailing Address - Fax:218-283-2392
Practice Address - Street 1:501 3RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2305
Practice Address - Country:US
Practice Address - Phone:218-283-2192
Practice Address - Fax:218-283-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty