Provider Demographics
NPI:1013591973
Name:PIVOTAL FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PIVOTAL FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-582-0582
Mailing Address - Street 1:16731 HIGHWAY 13 S STE 107A
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-2975
Mailing Address - Country:US
Mailing Address - Phone:320-582-0582
Mailing Address - Fax:
Practice Address - Street 1:16731 HIGHWAY 13 S STE 107A
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-2975
Practice Address - Country:US
Practice Address - Phone:320-582-0582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty