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PEQUOT LAKES CHIROPRACTIC PA NPI 1417540774


NPI Information

NPI: 1417540774
Provider Name: PEQUOT LAKES CHIROPRACTIC PA
Classification: Chiropractor - 111N00000X
Entity Type: Organization
Address:
31095 BERQUIST DR
PEQUOT LAKES, MN
ZIP 56472
Phone: (218) 568-7767
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PEQUOT LAKES CHIROPRACTIC PA is a chiropractor in Pequot Lakes, MN. The provider is a provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. PEQUOT LAKES CHIROPRACTIC PA NPI is 1417540774. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

31095 BERQUIST DR
PEQUOT LAKES, MN
ZIP 56472-647
Phone: (218) 568-7767
Fax: (218) 568-4580

The provider's authorized official is Joshua Alan Dietze .
The authorized official title is Owner and has the following contact phone number (218) 568-7677.

The enumeration date for this NPI number is 2/18/2021 and was last updated on 2/18/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1111N00000XChiropractorYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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