Provider Demographics
NPI:1962549089
Name:FAMILY WELLNESS CHIROPRACTIC, PC
Entity type:Organization
Organization Name:FAMILY WELLNESS CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PALOKANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-735-9971
Mailing Address - Street 1:9600 28TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3210
Mailing Address - Country:US
Mailing Address - Phone:763-546-4414
Mailing Address - Fax:
Practice Address - Street 1:9600 28TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3210
Practice Address - Country:US
Practice Address - Phone:763-546-4414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4560111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN351G1FAOtherBCBS