Provider Demographics
NPI:1437472503
Name:RUSHFORD CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:RUSHFORD CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:HINZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-864-8888
Mailing Address - Street 1:310 S MILL ST
Mailing Address - Street 2:PO BOX 601
Mailing Address - City:RUSHFORD
Mailing Address - State:MN
Mailing Address - Zip Code:55971-8824
Mailing Address - Country:US
Mailing Address - Phone:507-864-8888
Mailing Address - Fax:
Practice Address - Street 1:310 S MILL ST # 601
Practice Address - Street 2:
Practice Address - City:RUSHFORD
Practice Address - State:MN
Practice Address - Zip Code:55971-8824
Practice Address - Country:US
Practice Address - Phone:507-864-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2655261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1487870358OtherINDIVIDUAL NPI
MN421219300Medicaid
MN350002806Medicare PIN