Provider Demographics
NPI:1407985872
Name:FERNBROOK CHIRPRACTIC, LTD.
Entity Type:Organization
Organization Name:FERNBROOK CHIRPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:CLARENCE
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-201-1284
Mailing Address - Street 1:3169 FERNBROOK LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5357
Mailing Address - Country:US
Mailing Address - Phone:763-201-1284
Mailing Address - Fax:763-201-1285
Practice Address - Street 1:3169 FERNBROOK LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5357
Practice Address - Country:US
Practice Address - Phone:763-201-1284
Practice Address - Fax:763-201-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty