Healthcare Provider Details

I. General information

NPI: 1174040752
Provider Name (Legal Business Name): CHIPPEWA SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 BROADWAY ST STE 240
ALEXANDRIA MN
56308-2664
US

IV. Provider business mailing address

1210 BROADWAY ST STE 240
ALEXANDRIA MN
56308-2664
US

V. Phone/Fax

Practice location:
  • Phone: 225-588-4845
  • Fax: 225-612-6561
Mailing address:
  • Phone: 225-588-4845
  • Fax: 225-612-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: KATHY REED
Title or Position: MANAGER
Credential:
Phone: 225-588-4845