Provider Demographics
NPI:1326531476
Name:MGFAMCHIRO PLLC
Entity Type:Organization
Organization Name:MGFAMCHIRO PLLC
Other - Org Name:MAPLE GROVE FAMILY CHIROPRACTIC & ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SANATI-ZAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-777-5461
Mailing Address - Street 1:7372 KIRKWOOD CT N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5202
Mailing Address - Country:US
Mailing Address - Phone:763-777-5461
Mailing Address - Fax:763-777-8179
Practice Address - Street 1:7372 KIRKWOOD CT N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5202
Practice Address - Country:US
Practice Address - Phone:763-777-5461
Practice Address - Fax:763-777-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty