Provider Demographics
NPI:1053497057
Name:PIERZ CHIROPRACTIC CENTER, P.C
Entity Type:Organization
Organization Name:PIERZ CHIROPRACTIC CENTER, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GRUNST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-468-2561
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-0276
Mailing Address - Country:US
Mailing Address - Phone:320-468-2561
Mailing Address - Fax:320-468-2562
Practice Address - Street 1:129 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-0276
Practice Address - Country:US
Practice Address - Phone:320-468-2561
Practice Address - Fax:320-468-2562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN001745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0203OtherHEALTH SERVICES MANAGEMEN
MN013727800Medicaid
MN230293OtherCHIROPRACTI CARE OF MN
MN04S92PIOtherBLUE SHIELD OF MN
MN350001965Medicare ID - Type Unspecified
MN013727800Medicaid