MEDICARE: DR. RICHARD VINCENT OTTOMEYER 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	1818	MN
2	111NX0800X	Orthopedic Chiropractor	1818	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598752859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD VINCENT OTTOMEYER D.C.

Provider Business Mailing Address
First Line	:	23315 ITASCA AVE N
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-8277
Country	:	US
Telephone Number	:	651-226-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	168 LAKE ST S STE C
Second Line	:
City	:	FOREST LAKE
State	:	MN
Zip	:	55025-4401
Country	:	US
Telephone Number	:	651-226-8338
Fax Number	:

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	02/06/2020

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