Provider Demographics
NPI:1184049298
Name:NORTHWEST FAMILY CHIROPRACTIC PA
Entity type:Organization
Organization Name:NORTHWEST FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERNYAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:612-619-0386
Mailing Address - Street 1:7372 KIRKWOOD COURT
Mailing Address - Street 2:SUITE A
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:612-619-0386
Mailing Address - Fax:
Practice Address - Street 1:7372 KIRKWOOD COURT
Practice Address - Street 2:SUITE A
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:612-619-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4353111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty