Provider Demographics
NPI:1013441443
Name:CONSCIOUS CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CONSCIOUS CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAKENZIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:STEENERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-607-3872
Mailing Address - Street 1:13786 REIMER DR N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-2205
Mailing Address - Country:US
Mailing Address - Phone:763-337-4543
Mailing Address - Fax:
Practice Address - Street 1:13786 REIMER DR N
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-2205
Practice Address - Country:US
Practice Address - Phone:763-337-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6347111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1235678392OtherINDIVIDUAL NPI