Provider Demographics
NPI:1205905924
Name:GRAVON'S NATURAL CHIROPRACTIC CENTER P A
Entity type:Organization
Organization Name:GRAVON'S NATURAL CHIROPRACTIC CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNIEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-376-9771
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-0396
Mailing Address - Country:US
Mailing Address - Phone:507-376-9771
Mailing Address - Fax:507-376-9798
Practice Address - Street 1:1024 OXFORD ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1681
Practice Address - Country:US
Practice Address - Phone:507-376-9771
Practice Address - Fax:507-376-9798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAVONS NATURAL CHIROPRACTIC CENTER P A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-07
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN548527400Medicaid
MN350048116OtherRR MEDICARE PROVIDER NO
MN61964GROtherBCBS PROVIDER NUMBER