Provider Demographics
NPI:1124223359
Name:MCINTOSH FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:MCINTOSH FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:OSMONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-289-3478
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:250 CLEVELAND AVE
Mailing Address - City:MCINTOSH
Mailing Address - State:MN
Mailing Address - Zip Code:56556
Mailing Address - Country:US
Mailing Address - Phone:218-289-3478
Mailing Address - Fax:218-563-2043
Practice Address - Street 1:250 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MCINTOSH
Practice Address - State:MN
Practice Address - Zip Code:56556
Practice Address - Country:US
Practice Address - Phone:218-289-3478
Practice Address - Fax:218-563-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty