Provider Demographics
NPI:1821250127
Name:PRAIRIE FAMILY & SPORTS CHIROPRACTIC PA
Entity Type:Organization
Organization Name:PRAIRIE FAMILY & SPORTS CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:EISCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-583-2271
Mailing Address - Street 1:344 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMING PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55917-0395
Mailing Address - Country:US
Mailing Address - Phone:507-583-2271
Mailing Address - Fax:507-583-0040
Practice Address - Street 1:344 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMING PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55917-0395
Practice Address - Country:US
Practice Address - Phone:507-583-2271
Practice Address - Fax:507-583-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN815318300Medicaid
MN4C688PROtherBLUE CROSS BLUE SHIELD OF MN
MN4C688PROtherBLUE CROSS BLUE SHIELD OF MN