Provider Demographics
NPI:1093868184
Name:NORTHWOODS CHIROPRACTIC OF CHISAGO CITY PA
Entity Type:Organization
Organization Name:NORTHWOODS CHIROPRACTIC OF CHISAGO CITY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZVONAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-257-3914
Mailing Address - Street 1:11185 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHISAGO CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55013-9817
Mailing Address - Country:US
Mailing Address - Phone:651-257-3914
Mailing Address - Fax:651-257-3915
Practice Address - Street 1:11185 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:CHISAGO CITY
Practice Address - State:MN
Practice Address - Zip Code:55013-9817
Practice Address - Country:US
Practice Address - Phone:651-257-3914
Practice Address - Fax:651-257-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN003667111N00000X
MN002174111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN55P78ZVOtherBCBS CLINIC PROVIDER NO.
MN55P78ZVOtherBCBS CLINIC PROVIDER NO.