Provider Demographics
NPI:1568503670
Name:DUININCK CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:DUININCK CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:JANETTE
Authorized Official - Last Name:HORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-235-6320
Mailing Address - Street 1:1550 WILLMAR AVE SE, SUITE B
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201
Mailing Address - Country:US
Mailing Address - Phone:320-235-6320
Mailing Address - Fax:320-235-2542
Practice Address - Street 1:1550 WILLMAR AVE SE STE B
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4765
Practice Address - Country:US
Practice Address - Phone:320-235-6320
Practice Address - Fax:320-235-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN45177DUOtherBLUE CROSS&BLUE SHIELD MN
MNCG0997Medicare ID - Type UnspecifiedRR MEDICARE- PALMETTO GBA
MNC02691Medicare ID - Type UnspecifiedWISCONSIN PHYSICIAN SERV