Provider Demographics
NPI:1609061944
Name:SOUTH SHAKOPEE CHIROPRACTIC
Entity Type:Organization
Organization Name:SOUTH SHAKOPEE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONOVAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HAYOSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-451-3761
Mailing Address - Street 1:1830 MARSCHALL RD
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3310
Mailing Address - Country:US
Mailing Address - Phone:952-451-3761
Mailing Address - Fax:952-403-1006
Practice Address - Street 1:1830 MARSCHALL RD
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3310
Practice Address - Country:US
Practice Address - Phone:952-451-3761
Practice Address - Fax:952-403-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMBCE3466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty