Provider Demographics
NPI:1083222921
Name:CEDAR RIVER CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CEDAR RIVER CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-438-3851
Mailing Address - Street 1:1700 17TH ST NW STE 2B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-3486
Mailing Address - Country:US
Mailing Address - Phone:833-433-2225
Mailing Address - Fax:
Practice Address - Street 1:1700 17TH ST NW STE 2B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-3486
Practice Address - Country:US
Practice Address - Phone:833-433-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty