Provider Demographics
NPI:1063678357
Name:CHIROPRACTIC CONNECTION PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CONNECTION PLLC
Other - Org Name:CHIROPRACTIC CONNECTION
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHLEPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-252-2703
Mailing Address - Street 1:2103 FRONTAGE RD N
Mailing Address - Street 2:#19
Mailing Address - City:WAITE PARK
Mailing Address - State:MN
Mailing Address - Zip Code:56387
Mailing Address - Country:US
Mailing Address - Phone:320-252-2703
Mailing Address - Fax:320-229-2647
Practice Address - Street 1:2103 FRONTAGE RD N
Practice Address - Street 2:#19
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387
Practice Address - Country:US
Practice Address - Phone:320-252-2703
Practice Address - Fax:320-229-2647
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIROPRACTIC CONNECTION PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
316P4CHOtherBLUE CROSS BS
MN350003562Medicare UPIN