Provider Demographics
NPI:1790031938
Name:ELMORE FAMILY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ELMORE FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:LOUISE AUNE
Authorized Official - Last Name:ELMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-721-2341
Mailing Address - Street 1:504 S MANTORVILLE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:KASSON
Mailing Address - State:MN
Mailing Address - Zip Code:55944-2206
Mailing Address - Country:US
Mailing Address - Phone:507-634-7288
Mailing Address - Fax:507-634-7290
Practice Address - Street 1:504 S MANTORVILLE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:KASSON
Practice Address - State:MN
Practice Address - Zip Code:55944-2206
Practice Address - Country:US
Practice Address - Phone:507-634-7288
Practice Address - Fax:507-634-7290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty