Provider Demographics
NPI:1962738443
Name:FAMILY FIRST CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:FAMILY FIRST CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:APRIL
Authorized Official - Last Name:RAKOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-785-4120
Mailing Address - Street 1:12203 ABERDEEN ST NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5174
Mailing Address - Country:US
Mailing Address - Phone:763-785-4120
Mailing Address - Fax:763-785-4172
Practice Address - Street 1:12203 ABERDEEN ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5174
Practice Address - Country:US
Practice Address - Phone:763-785-4120
Practice Address - Fax:763-785-4172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5158111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty