Provider Demographics
NPI:1609007202
Name:KAVANAGH CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:KAVANAGH CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-445-9313
Mailing Address - Street 1:500 MARSCHALL ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2693
Mailing Address - Country:US
Mailing Address - Phone:952-445-9313
Mailing Address - Fax:952-445-9313
Practice Address - Street 1:440 110TH AVE SE
Practice Address - Street 2:
Practice Address - City:DE GRAFF
Practice Address - State:MN
Practice Address - Zip Code:56271-9071
Practice Address - Country:US
Practice Address - Phone:612-590-3899
Practice Address - Fax:952-445-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4998111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty