Provider Demographics
NPI:1649586645
Name:SACRED HEALTH FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:SACRED HEALTH FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOGAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRINCEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-467-2132
Mailing Address - Street 1:306 W HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:NORWOOD YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55368-9775
Mailing Address - Country:US
Mailing Address - Phone:952-467-2132
Mailing Address - Fax:952-467-2549
Practice Address - Street 1:306 W HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:NORWOOD YOUNG AMERICA
Practice Address - State:MN
Practice Address - Zip Code:55368-9775
Practice Address - Country:US
Practice Address - Phone:952-467-2132
Practice Address - Fax:952-467-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5361111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty