Healthcare Provider Details

I. General information

NPI: 1467411264
Provider Name (Legal Business Name): MARK PAPPENFUS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10824 STANLEY AVE S
BLOOMINGTON MN
55437-3333
US

IV. Provider business mailing address

PO BOX 385523
MINNEAPOLIS MN
55438-5523
US

V. Phone/Fax

Practice location:
  • Phone: 651-699-4169
  • Fax:
Mailing address:
  • Phone: 651-699-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2508
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: