Provider Demographics
NPI:1174759476
Name:KOFORD CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:KOFORD CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-826-2320
Mailing Address - Street 1:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:DANUBE
Mailing Address - State:MN
Mailing Address - Zip Code:56230-0185
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:203 OAK ST
Practice Address - Street 2:
Practice Address - City:DANUBE
Practice Address - State:MN
Practice Address - Zip Code:56230
Practice Address - Country:US
Practice Address - Phone:320-823-2320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN039227800Medicaid
MN62778KOOtherBLUE CROSS BLUE SHIELD OF MINNESOTA