Healthcare Provider Details

I. General information

NPI: 1932368883
Provider Name (Legal Business Name): REGIONAL HEALTH CENTER OF AVON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 AVON AVE S SUITE F
AVON MN
56310-4528
US

IV. Provider business mailing address

PO BOX 416
AVON MN
56310-0416
US

V. Phone/Fax

Practice location:
  • Phone: 320-356-1023
  • Fax: 320-356-1033
Mailing address:
  • Phone: 320-356-1023
  • Fax: 320-356-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number003166
License Number StateMN

VIII. Authorized Official

Name: JENNIFER ANDREA LOUREY DOLL
Title or Position: PRESIDENT
Credential: DC
Phone: 320-597-8999