Provider Demographics
NPI:1033267968
Name:NASHWAUK CHIROPRACTIC PC
Entity Type:Organization
Organization Name:NASHWAUK CHIROPRACTIC PC
Other - Org Name:DEBRA WARD MEADOWS DC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WARD MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-885-2070
Mailing Address - Street 1:113 FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1103
Mailing Address - Country:US
Mailing Address - Phone:218-885-2070
Mailing Address - Fax:218-885-2070
Practice Address - Street 1:113 FIRST STREET
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1103
Practice Address - Country:US
Practice Address - Phone:218-885-2070
Practice Address - Fax:218-885-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3867 454111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN66B83NAOtherBLUE CROSS BLUE SHIELD
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