Provider Demographics
NPI:1811146301
Name:SOUTHWEST FAMILY CHIROPRACTIC P.L.C.
Entity type:Organization
Organization Name:SOUTHWEST FAMILY CHIROPRACTIC P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:DETERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:507-247-3249
Mailing Address - Street 1:100 E HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-1101
Mailing Address - Country:US
Mailing Address - Phone:507-247-3249
Mailing Address - Fax:507-247-3250
Practice Address - Street 1:100 E HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:MN
Practice Address - Zip Code:56178-1101
Practice Address - Country:US
Practice Address - Phone:507-247-3249
Practice Address - Fax:507-247-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty