Provider Demographics
NPI:1497951073
Name:PIPESTONE FAMILY CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:PIPESTONE FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:L
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-825-2214
Mailing Address - Street 1:222 2ND AVE SW
Mailing Address - Street 2:PO BOX 394
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1669
Mailing Address - Country:US
Mailing Address - Phone:507-825-2214
Mailing Address - Fax:
Practice Address - Street 1:222 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1669
Practice Address - Country:US
Practice Address - Phone:507-825-2214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04016009Medicaid
MNCO3429Medicare ID - Type UnspecifiedMEDICARE