| Functional Chiropractic Rehab, Pllc | |
|
1901 Madison Ave Ste 120 Mankato MN 56001-6267 | |
| (605) 380-4364 | |
| Not Available |
| Full Name | Functional Chiropractic Rehab, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1901 Madison Ave Ste 120, Mankato, Minnesota |
| Authorized Official Name and Position | Benjamin Martin Hansen (OWNER) |
| Authorized Official Contact | 6053804364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Functional Chiropractic Rehab, Pllc 1901 Madison Ave Ste 120 Mankato MN 56001-6267 Ph: (605) 380-4364 | Functional Chiropractic Rehab, Pllc 1901 Madison Ave Ste 120 Mankato MN 56001-6267 Ph: (605) 380-4364 |
| NPI Number | 1073149779 |
|---|---|
| Provider Enumeration Date | 03/14/2020 |
| Last Update Date | 04/01/2020 |
| Medicare PECOS PAC ID | 4082045828 |
|---|---|
| Medicare Enrollment ID | O20200512002661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073149779 | NPI | - | NPPES |
| 1326676412 | Other | MN | NATIONAL PROVIDER IDENTIFIER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Benjamin Hansen |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1326676412 PECOS PAC ID: 5991136731 Enrollment ID: I20200512002817 |
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