Provider Demographics
NPI:1518140409
Name:RIVER VALLEY CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:RIVER VALLEY CHIROPRACTIC INC.
Other - Org Name:RIVER VALLEY CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYOVN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEHNAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-267-0394
Mailing Address - Street 1:104 BURNSIDE AVE S
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-1928
Mailing Address - Country:US
Mailing Address - Phone:651-267-0394
Mailing Address - Fax:651-267-0395
Practice Address - Street 1:104 BURNSIDE AVE S
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-1928
Practice Address - Country:US
Practice Address - Phone:651-267-0394
Practice Address - Fax:651-267-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3644261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center