Provider Demographics
NPI:1225218282
Name:COMPLETE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:MODORY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-645-3176
Mailing Address - Street 1:303 HESTER ST W
Mailing Address - Street 2:
Mailing Address - City:DUNDAS
Mailing Address - State:MN
Mailing Address - Zip Code:55019-3970
Mailing Address - Country:US
Mailing Address - Phone:507-645-0333
Mailing Address - Fax:
Practice Address - Street 1:303 HESTER ST W
Practice Address - Street 2:
Practice Address - City:DUNDAS
Practice Address - State:MN
Practice Address - Zip Code:55019-3970
Practice Address - Country:US
Practice Address - Phone:507-645-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4075111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty