Organization
GREEN LAKE CHIROPRACTIC, PA
Active
Organization
GREEN LAKE CHIROPRACTIC, PA
Active
Other names
Meridian Disc Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON D. HAEFNER D.C. (PRESIDENT)
(320) 214-0044
Entity
Organization
Contact information
Practice address
205 5TH ST SW, WILLMAR, MN 56201-3211
(320) 214-0044
(320) 214-0045
Mailing address
205 5TH ST SW, WILLMAR, MN 56201-3211
(320) 214-0044
(320) 214-0045
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
4176
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
062M1GR
MN BCBS
MN
01
—
0868
HEALTH SERVICE MGMT.
MN
01
—
627686
ACN GROUP
MN
Enumeration date
02/05/2008
Last updated
06/02/2008
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