Provider Demographics
NPI:1104374933
Name:ANOKA FAMILY CHIROPRACTIC P.A,
Entity Type:Organization
Organization Name:ANOKA FAMILY CHIROPRACTIC P.A,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-427-7869
Mailing Address - Street 1:1902 5TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2578
Mailing Address - Country:US
Mailing Address - Phone:763-427-7869
Mailing Address - Fax:763-427-3260
Practice Address - Street 1:1902 5TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-2578
Practice Address - Country:US
Practice Address - Phone:763-427-7869
Practice Address - Fax:763-427-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty