Provider Demographics
NPI:1942400940
Name:NORTHERN FAMILY CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:NORTHERN FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:218-822-3855
Mailing Address - Street 1:13968 CYPRESS DR
Mailing Address - Street 2:STE 1B
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-5903
Mailing Address - Country:US
Mailing Address - Phone:218-822-3855
Mailing Address - Fax:218-822-3854
Practice Address - Street 1:13968 CYPRESS DR
Practice Address - Street 2:STE 1B
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-5903
Practice Address - Country:US
Practice Address - Phone:218-822-3855
Practice Address - Fax:218-822-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN088450200Medicaid
MN350002981Medicare PIN
MN088450200Medicaid