Provider Demographics
NPI:1578624839
Name:HEALTH FIRST CHIROPRACTIC OF BAXTER
Entity Type:Organization
Organization Name:HEALTH FIRST CHIROPRACTIC OF BAXTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PROUTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-829-8414
Mailing Address - Street 1:14213 GOLF COURSE DRIVE SUITE 105
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-829-8414
Mailing Address - Fax:218-828-2005
Practice Address - Street 1:14213 GOLF COURSE DRIVE SUITE 105
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-829-8414
Practice Address - Fax:218-828-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN44G66HEOtherBCBS
MNCJ6081OtherRR MEDICARE
MNC03030Medicare ID - Type Unspecified