Provider Demographics
NPI:1821074089
Name:RICH PRAIRIE CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:RICH PRAIRIE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JUETTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-468-2221
Mailing Address - Street 1:232 MAIN ST N
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:PIERZ
Mailing Address - State:MN
Mailing Address - Zip Code:56364-1517
Mailing Address - Country:US
Mailing Address - Phone:320-468-2221
Mailing Address - Fax:
Practice Address - Street 1:232 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-1517
Practice Address - Country:US
Practice Address - Phone:320-468-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-20
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN002959111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3K7060NOtherBLUE CROSS
MN3K7060NOtherBLUE CROSS