Provider Demographics
NPI:1568925097
Name:PREMIER CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PREMIER CHIROPRACTIC LLC
Other - Org Name:EYOTA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTPHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-797-8138
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:EYOTA
Mailing Address - State:MN
Mailing Address - Zip Code:55934-0057
Mailing Address - Country:US
Mailing Address - Phone:507-585-0528
Mailing Address - Fax:
Practice Address - Street 1:123 LAFAYETTE AVE SW
Practice Address - Street 2:
Practice Address - City:EYOTA
Practice Address - State:MN
Practice Address - Zip Code:55934-6507
Practice Address - Country:US
Practice Address - Phone:608-797-8138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty