Provider Demographics
NPI:1679668933
Name:FALLS ADVANCED CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FALLS ADVANCED CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-283-2243
Mailing Address - Street 1:1322 THIRD STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649
Mailing Address - Country:US
Mailing Address - Phone:218-283-2243
Mailing Address - Fax:218-285-3608
Practice Address - Street 1:1322 THIRD STREET
Practice Address - Street 2:SUITE 4
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649
Practice Address - Country:US
Practice Address - Phone:218-283-2243
Practice Address - Fax:218-285-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty