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Organization
NORTHLAND CHIROPRACTIC CENTER PA
Active
Organization
NORTHLAND CHIROPRACTIC CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER ELYSE PEDERSEN DC (OWNER)
(218) 844-5050
Entity
Organization
Contact information
Practice address
516 MAIN STREET EAST, DETROIT LAKES, MN 56501
(218) 844-5050
(218) 844-5049
Mailing address
516 MAIN STREET EAST, DETROIT LAKES, MN 56501
(218) 844-5050
(218) 844-5049
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
171100000X
Acupuncturist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020960100
—
MN
01
—
242T6N0
BCBS OF MN
—
01
—
647163
CHIROCARE OF MN
—
Enumeration date
03/27/2007
Last updated
01/20/2012
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