MEDICARE: DR. ERIC JOSEPH MEDELBERG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3062	MN

General Provider Information

NPI Number	:	1487705190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC JOSEPH MEDELBERG D.C.

Provider Business Mailing Address
First Line	:	710 COUNTY ROAD 75
Second Line	:	SUITE 103
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-8648
Country	:	US
Telephone Number	:	320-271-1800
Fax Number	:	320-271-1808

Provider Business Practice Location Address
First Line	:	710 COUNTY ROAD 75
Second Line	:	SUITE 103
City	:	SAINT JOSEPH
State	:	MN
Zip	:	56374-8648
Country	:	US
Telephone Number	:	320-271-1800
Fax Number	:	320-271-1808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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