Provider Demographics
NPI:1497893911
Name:PETER FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:PETER FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-452-8333
Mailing Address - Street 1:750 HIGHWAY 110
Mailing Address - Street 2:STE 13
Mailing Address - City:MENDOTA HGTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120
Mailing Address - Country:US
Mailing Address - Phone:651-452-8333
Mailing Address - Fax:651-452-0387
Practice Address - Street 1:750 HIGHWAY 110
Practice Address - Street 2:STE 13
Practice Address - City:MENDOTA HGTS
Practice Address - State:MN
Practice Address - Zip Code:55120
Practice Address - Country:US
Practice Address - Phone:651-452-8333
Practice Address - Fax:651-452-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
392LOPEOtherBCBS CLINIC #
392LIPEOtherBCBS PERSONAL #
231512OtherCHIRO CARE OF MN