Provider Demographics
NPI:1083882849
Name:CEDAR CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:CEDAR CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:GFRERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-451-0051
Mailing Address - Street 1:130 26TH ST NW
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-1264
Mailing Address - Country:US
Mailing Address - Phone:507-451-0051
Mailing Address - Fax:507-451-0733
Practice Address - Street 1:130 26TH ST NW
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-1264
Practice Address - Country:US
Practice Address - Phone:507-451-0051
Practice Address - Fax:507-451-0733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2709111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU29380Medicare UPIN