Provider Demographics
NPI:1467524371
Name:JACKSON CHIROPRACTIC OF LAKE CRYSTAL
Entity Type:Organization
Organization Name:JACKSON CHIROPRACTIC OF LAKE CRYSTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-847-3285
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:LAKE CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:56055-0068
Mailing Address - Country:US
Mailing Address - Phone:507-726-2716
Mailing Address - Fax:507-726-6482
Practice Address - Street 1:242 HIWAY 60
Practice Address - Street 2:UNIT 4
Practice Address - City:LAKE CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:56055
Practice Address - Country:US
Practice Address - Phone:507-726-2530
Practice Address - Fax:507-726-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty