Provider Demographics
NPI:1437693314
Name:KARLSTAD FAMILY CHIROPRACTIC P.A.
Entity Type:Organization
Organization Name:KARLSTAD FAMILY CHIROPRACTIC P.A.
Other - Org Name:JANA RILEY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-436-4264
Mailing Address - Street 1:205 ROOSEVELT AVE W
Mailing Address - Street 2:
Mailing Address - City:KARLSTAD
Mailing Address - State:MN
Mailing Address - Zip Code:56732-4022
Mailing Address - Country:US
Mailing Address - Phone:218-436-4264
Mailing Address - Fax:
Practice Address - Street 1:205 ROOSEVELT AVE W
Practice Address - Street 2:
Practice Address - City:KARLSTAD
Practice Address - State:MN
Practice Address - Zip Code:56732-4022
Practice Address - Country:US
Practice Address - Phone:218-436-4264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty