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Organization
FAMILY CHIROPRACTIC OF SHAKOPEE, P.A.
Active
Organization
FAMILY CHIROPRACTIC OF SHAKOPEE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LESLIE HARDER D.C. (PRESIDENT)
(952) 445-0679
Entity
Organization
Contact information
Practice address
1221 4TH AVE E, SUITE 120, SHAKOPEE, MN 55379-1681
(952) 445-0679
(952) 445-6979
Mailing address
1221 4TH AVE E, SUITE 120, SHAKOPEE, MN 55379-1681
(952) 445-0679
(952) 445-6979
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3128
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4C223FA
BCBS PROVIDER CLINIC NO
MN
05
—
512718100
—
MN
Enumeration date
02/16/2010
Last updated
02/22/2010
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