Provider Demographics
NPI:1841465515
Name:STILLWATER FAMILY CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:STILLWATER FAMILY CHIROPRACTIC CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOXHOVEN
Authorized Official - Suffix:I
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:651-439-2004
Mailing Address - Street 1:6750 STILLWATER BLVD N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-5485
Mailing Address - Country:US
Mailing Address - Phone:651-439-2004
Mailing Address - Fax:651-689-1636
Practice Address - Street 1:6750 N STILLWATER BLVD. N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082
Practice Address - Country:US
Practice Address - Phone:651-439-2004
Practice Address - Fax:651-689-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization