Provider Demographics
NPI:1255817839
Name:ANCHOR CHIROPRACTIC PC
Entity type:Organization
Organization Name:ANCHOR CHIROPRACTIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:RICHTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-424-5511
Mailing Address - Street 1:20965 S DIAMOND LAKE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-4821
Mailing Address - Country:US
Mailing Address - Phone:763-424-5511
Mailing Address - Fax:763-424-3255
Practice Address - Street 1:20965 S DIAMOND LAKE RD STE 108
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-4821
Practice Address - Country:US
Practice Address - Phone:763-424-5511
Practice Address - Fax:763-424-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty