Provider Demographics
NPI:1851692289
Name:EAGAN FAMILY CHIROPRACTIC & MASSAGE
Entity Type:Organization
Organization Name:EAGAN FAMILY CHIROPRACTIC & MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RECER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:651-405-3990
Mailing Address - Street 1:1260 YANKEE DOODLE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121
Mailing Address - Country:US
Mailing Address - Phone:651-405-3990
Mailing Address - Fax:651-454-8577
Practice Address - Street 1:1260 YANKEE DOODLE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121
Practice Address - Country:US
Practice Address - Phone:651-405-3990
Practice Address - Fax:651-454-8577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty