Healthcare Provider Details

I. General information

NPI: 1699984195
Provider Name (Legal Business Name): DALE NORRIS MORTENSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 POLK ST STE A
SAN FRANCISCO CA
94109-2549
US

IV. Provider business mailing address

2041 POLK ST STE A
SAN FRANCISCO CA
94109-2549
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-3667
  • Fax:
Mailing address:
  • Phone: 415-673-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC17526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: