Provider Demographics
NPI:1497821433
Name:SPECIFIC FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SPECIFIC FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BIERNAT
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:651-415-0418
Mailing Address - Street 1:2785 WHITE BEAR AVE N
Mailing Address - Street 2:108
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1307
Mailing Address - Country:US
Mailing Address - Phone:651-415-0418
Mailing Address - Fax:651-415-0106
Practice Address - Street 1:2785 WHITE BEAR AVE N
Practice Address - Street 2:108
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1307
Practice Address - Country:US
Practice Address - Phone:651-415-0418
Practice Address - Fax:651-415-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00D05SPOtherBCBS