Provider Demographics
NPI:1578799870
Name:CHILD AND FAMILY CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:CHILD AND FAMILY CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DICCP
Authorized Official - Phone:612-590-5881
Mailing Address - Street 1:4444 W. 76TH ST.,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:612-590-5881
Mailing Address - Fax:612-886-8058
Practice Address - Street 1:4444 W. 76TH ST.,
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:612-590-5881
Practice Address - Fax:612-886-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4414111NP0017X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05326Medicare UPIN