Provider Demographics
NPI:1922889724
Name:COUNTRY CARE CHIROPRACTIC
Entity Type:Organization
Organization Name:COUNTRY CARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-290-0308
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:KILKENNY
Mailing Address - State:MN
Mailing Address - Zip Code:56052-0114
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41614 GORMAN LAKE RD
Practice Address - Street 2:
Practice Address - City:LE CENTER
Practice Address - State:MN
Practice Address - Zip Code:56057-4083
Practice Address - Country:US
Practice Address - Phone:952-290-0308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty