Provider Demographics
NPI:1306040381
Name:AFTON CHIROPRACTIC CLINIC PA
Entity Type:Organization
Organization Name:AFTON CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMIE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:CAULDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-436-7757
Mailing Address - Street 1:44 SAINT CROIX TRL S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKELAND
Mailing Address - State:MN
Mailing Address - Zip Code:55043-8404
Mailing Address - Country:US
Mailing Address - Phone:651-436-7757
Mailing Address - Fax:
Practice Address - Street 1:44 SAINT CROIX TRL S
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKELAND
Practice Address - State:MN
Practice Address - Zip Code:55043-8404
Practice Address - Country:US
Practice Address - Phone:651-436-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN98D84QUOtherBCBS
WI38963000OtherBADGERCARE
MN200967600Medicaid
MN97G19CAOtherBCBS
MN618323900Medicaid
WI38962900OtherBADGERCARE
WI38963000OtherBADGERCARE