Provider Demographics
NPI:1114115029
Name:CHAFFEE CHIROPRACTIC PA
Entity Type:Organization
Organization Name:CHAFFEE CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-749-0899
Mailing Address - Street 1:201 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-2717
Mailing Address - Country:US
Mailing Address - Phone:218-749-0899
Mailing Address - Fax:218-741-5702
Practice Address - Street 1:201 6TH ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-2717
Practice Address - Country:US
Practice Address - Phone:218-749-0899
Practice Address - Fax:218-741-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4087111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04118OtherMEDICARE PROVIDER NUMBER