Provider Demographics
NPI:1023209541
Name:HOISINGTON FAMILY CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:HOISINGTON FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOISINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-332-8623
Mailing Address - Street 1:1033 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5407
Mailing Address - Country:US
Mailing Address - Phone:507-332-8623
Mailing Address - Fax:507-331-3122
Practice Address - Street 1:1033 1ST ST NE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5407
Practice Address - Country:US
Practice Address - Phone:507-332-8623
Practice Address - Fax:507-331-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN94G04HOOtherBLUE CROSS BLUE SHIELD
MN318695400OtherMEDICAL ASSISTANCE
MNV06472Medicare UPIN
MNC04058Medicare PIN