Provider Demographics
NPI:1699837708
Name:MCR, IRIS PARK CHIROPRACTIC
Entity Type:Organization
Organization Name:MCR, IRIS PARK CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-451-9155
Mailing Address - Street 1:1828 S CEDAR AVE # 2
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-4204
Mailing Address - Country:US
Mailing Address - Phone:507-451-9155
Mailing Address - Fax:
Practice Address - Street 1:1828 S CEDAR AVE # 2
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-4204
Practice Address - Country:US
Practice Address - Phone:507-451-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1551261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center