Provider Demographics
NPI:1518942416
Name:CENTER FOR FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:CENTER FOR FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:B
Authorized Official - Last Name:EICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-474-1530
Mailing Address - Street 1:601 E SANBORN ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4365
Mailing Address - Country:US
Mailing Address - Phone:507-474-1530
Mailing Address - Fax:
Practice Address - Street 1:601 E SANBORN ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4365
Practice Address - Country:US
Practice Address - Phone:507-474-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN294K1CEOtherBLUE CROSS BLUE SHIELD ID
MN923179000Medicaid
MNC03605OtherPTAN