Provider Demographics
NPI:1255685624
Name:EDINA FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:EDINA FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-388-0868
Mailing Address - Street 1:3925 W 50TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1247
Mailing Address - Country:US
Mailing Address - Phone:952-388-0868
Mailing Address - Fax:
Practice Address - Street 1:3925 W 50TH ST STE 202
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1247
Practice Address - Country:US
Practice Address - Phone:952-388-0868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCO9253Medicare PIN