Provider Demographics
NPI:1023398138
Name:MINNETONKA FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:MINNETONKA FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JON
Authorized Official - Last Name:GIANFORTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-322-0323
Mailing Address - Street 1:11349 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5300
Mailing Address - Country:US
Mailing Address - Phone:952-229-8750
Mailing Address - Fax:
Practice Address - Street 1:11349 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-5300
Practice Address - Country:US
Practice Address - Phone:952-229-8750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2011-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care