Provider Demographics
NPI:1548331127
Name:RIVER VALLEY FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:RIVER VALLEY FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:GANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-873-4275
Mailing Address - Street 1:210 N MERIDIAN ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011-1828
Mailing Address - Country:US
Mailing Address - Phone:952-873-4275
Mailing Address - Fax:952-873-4288
Practice Address - Street 1:210 N MERIDIAN ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011-1828
Practice Address - Country:US
Practice Address - Phone:952-873-4275
Practice Address - Fax:952-873-4288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3C336RIOtherBLUECROSS BLUESHIELD
U44528Medicare UPIN