Provider Demographics
NPI:1376721878
Name:CHIROPRACTIC FIRST
Entity Type:Organization
Organization Name:CHIROPRACTIC FIRST
Other - Org Name:CHIROPRACTICUSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:WILLCOCKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-476-2260
Mailing Address - Street 1:1850 W WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55356-9491
Mailing Address - Country:US
Mailing Address - Phone:952-476-2260
Mailing Address - Fax:952-476-4457
Practice Address - Street 1:1850 W WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:LONG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55356-9491
Practice Address - Country:US
Practice Address - Phone:952-476-2260
Practice Address - Fax:952-476-4457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3845111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty