Provider Demographics
NPI:1134359714
Name:MEADOW AREA CHIROPRACTIC LLC
Entity type:Organization
Organization Name:MEADOW AREA CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DILLON
Authorized Official - Middle Name:CARTER
Authorized Official - Last Name:DENISEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-754-4545
Mailing Address - Street 1:209 2ND AVE. NE
Mailing Address - Street 2:P.O. BOX 508
Mailing Address - City:GRAND MEADOW
Mailing Address - State:MN
Mailing Address - Zip Code:55936
Mailing Address - Country:US
Mailing Address - Phone:507-754-4545
Mailing Address - Fax:507-754-4546
Practice Address - Street 1:209 2ND AVE. NE
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND MEADOW
Practice Address - State:MN
Practice Address - Zip Code:55936
Practice Address - Country:US
Practice Address - Phone:507-754-4545
Practice Address - Fax:507-754-4546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5199261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care