Crow Wing Chiropractic Pc | |
15229 Edgewood Dr Ste 125, Baxter, MN 56401-6920 | |
(218) 205-1908 | |
Not Available |
Full Name | Crow Wing Chiropractic Pc |
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Type | Facility |
Speciality | Chiropractor |
Location | 15229 Edgewood Dr Ste 125, Baxter, Minnesota |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1154741288 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | 5700 (Minnesota) | Primary |
Provider Name | Jedediah W Moore |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1811246192 PECOS PAC ID: 7618128760 Enrollment ID: I20121119000319 |
Mailing Address | Practice Location Address |
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Crow Wing Chiropractic Pc 15229 Edgewood Dr Ste 125, Baxter, MN 56425 Ph: (218) 454-2840 | Crow Wing Chiropractic Pc 15229 Edgewood Dr Ste 125, Baxter, MN 56401-6920 Ph: (218) 205-1908 |
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