Provider Demographics
NPI:1275796153
Name:WRIGHT COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:WRIGHT COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-682-9779
Mailing Address - Street 1:1100 HIGHWAY 25 N
Mailing Address - Street 2:#4
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2023
Mailing Address - Country:US
Mailing Address - Phone:763-682-9779
Mailing Address - Fax:
Practice Address - Street 1:1100 HIGHWAY 25 N
Practice Address - Street 2:#4
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2023
Practice Address - Country:US
Practice Address - Phone:763-682-9779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2694111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN273028600Medicaid
MN273028600Medicaid