MEDICARE: NORTHGATE HEALTH CLINIC, P.A.

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	2236753	MN

General Provider Information

NPI Number	:	1720153745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHGATE HEALTH CLINIC, P.A.

Provider Business Mailing Address
First Line	:	600 11TH AVENUE NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-1805
Country	:	US
Telephone Number	:	507-285-1677
Fax Number	:	507-285-0052

Provider Business Practice Location Address
First Line	:	600 11TH AVENUE NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-1805
Country	:	US
Telephone Number	:	507-285-1677
Fax Number	:	507-285-0052

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TODD JAY BUCHANAN
Credential	:	D.C.
Telephone Number	:	507-285-1677

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	12/18/2019

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