Provider Demographics
NPI:1497872360
Name:STONEBROOK FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:STONEBROOK FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-461-6336
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:NEW MARKET
Mailing Address - State:MN
Mailing Address - Zip Code:55054-0105
Mailing Address - Country:US
Mailing Address - Phone:952-461-6336
Mailing Address - Fax:
Practice Address - Street 1:321 MAIN STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW MARKET
Practice Address - State:MN
Practice Address - Zip Code:55054
Practice Address - Country:US
Practice Address - Phone:952-461-6336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04167Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER