Organization
BRAATEN CHIROPRACTIC LLC
Active
Other names
Imagine Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
JILL MARIE BRAATEN DC (OWNER)
(320) 240-6561
Entity
Organization
Contact information
Practice address
750 1ST. ST. S. STE 103, WAITE PARK, MN 56387
(320) 240-6561
(320) 240-9331
Mailing address
750 1ST. ST. STE 103, WAITE PARK, MN 56387
(320) 240-6561
(320) 240-9331
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4986
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36M20IM
BLUE CROSS BLUE SHIELD GROUP PROVIDER ID
MN
01
—
C04865
MEDICARE GROUP PTAN
MN
Enumeration date
01/25/2008
Last updated
01/13/2015
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