Healthcare Provider Details

I. General information

NPI: 1710007620
Provider Name (Legal Business Name): PAPPENFUS CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/22/2020
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 385523-5523
BLOOMINGTON 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: DR. MARK RICHARD PAPPENFUS
Title or Position: OWNER
Credential: DC
Phone: 651-699-4169