Provider Demographics
NPI:1780807883
Name:CEDAR CREEK FAMILY CHIROPRACTIC PA
Entity type:Organization
Organization Name:CEDAR CREEK FAMILY CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:320-310-4000
Mailing Address - Street 1:203 COOPER AVENUE NORTH
Mailing Address - Street 2:SUITE #160
Mailing Address - City:ST. CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4446
Mailing Address - Country:US
Mailing Address - Phone:320-310-4000
Mailing Address - Fax:320-253-1575
Practice Address - Street 1:203 COOPER AVENUE NORTH
Practice Address - Street 2:SUITE #160
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4446
Practice Address - Country:US
Practice Address - Phone:320-310-4000
Practice Address - Fax:320-253-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty