Provider Demographics
NPI:1710183439
Name:CARDINAL FAMILY CHIROPRACTIC, LTD.
Entity Type:Organization
Organization Name:CARDINAL FAMILY CHIROPRACTIC, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-698-4180
Mailing Address - Street 1:7701 YORK AVE S
Mailing Address - Street 2:SUITE #155
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5238
Mailing Address - Country:US
Mailing Address - Phone:952-698-4180
Mailing Address - Fax:952-698-4179
Practice Address - Street 1:7701 YORK AVE S
Practice Address - Street 2:SUITE #155
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5238
Practice Address - Country:US
Practice Address - Phone:952-698-4180
Practice Address - Fax:952-698-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4282111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1982618187OtherNPI-PERSONAL#
MN606K9CAOtherBLUE CROSS BLUE SHIELD
MN1982618187OtherNPI-PERSONAL#