Provider Demographics
NPI:1346594223
Name:FAMILY CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-893-4412
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:MN
Mailing Address - Zip Code:56098-0296
Mailing Address - Country:US
Mailing Address - Phone:507-893-4412
Mailing Address - Fax:507-893-4912
Practice Address - Street 1:115 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:MN
Practice Address - Zip Code:56098-1015
Practice Address - Country:US
Practice Address - Phone:507-893-4412
Practice Address - Fax:507-893-4912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN401527400Medicaid
MN401527400Medicaid