Provider Demographics
NPI:1477764587
Name:ABC FAMILY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:ABC FAMILY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAULY
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:952-443-3710
Mailing Address - Street 1:1405 78TH ST STE 100
Mailing Address - Street 2:PO BOX 93
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-9723
Mailing Address - Country:US
Mailing Address - Phone:952-443-3710
Mailing Address - Fax:952-443-3761
Practice Address - Street 1:1405 78TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:VICTORIA
Practice Address - State:MN
Practice Address - Zip Code:55386-9723
Practice Address - Country:US
Practice Address - Phone:952-443-3710
Practice Address - Fax:952-443-3761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4549111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty