Provider Demographics
NPI:1740497452
Name:LAVIN FAMILY CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:LAVIN FAMILY CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-564-1870
Mailing Address - Street 1:665 HWY 212 WEST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GRANITE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56285
Mailing Address - Country:US
Mailing Address - Phone:320-564-1870
Mailing Address - Fax:320-564-1894
Practice Address - Street 1:665 HWY 212 WEST
Practice Address - Street 2:SUITE 1
Practice Address - City:GRANITE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56285
Practice Address - Country:US
Practice Address - Phone:320-564-1870
Practice Address - Fax:320-564-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0003107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN231767OtherACN
MN0425OtherHSM
MN3C217LAOtherBCBS
MN0425OtherHSM
U42791Medicare UPIN