Provider Demographics
NPI:1639344799
Name:JANESVILLE FAMILY CHIROPRACTIC CENTER LTD
Entity Type:Organization
Organization Name:JANESVILLE FAMILY CHIROPRACTIC CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MC COY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-234-5134
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:133 N MAIN
Mailing Address - City:JANESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56048-0148
Mailing Address - Country:US
Mailing Address - Phone:507-234-5134
Mailing Address - Fax:507-234-5134
Practice Address - Street 1:133 N MAIN
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56048-0148
Practice Address - Country:US
Practice Address - Phone:507-234-5134
Practice Address - Fax:507-234-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2529111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty