Healthcare Provider Details

I. General information

NPI: 1972680940
Provider Name (Legal Business Name): VALLEY WEST CHIROPRACTIC CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 NORMANDALE BLVD
BLOOMINGTON MN
55437-2700
US

IV. Provider business mailing address

10700 NORMANDALE BLVD
BLOOMINGTON MN
55437-2700
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-5805
  • Fax: 952-888-7563
Mailing address:
  • Phone: 952-888-5805
  • Fax: 952-888-7563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number27
License Number StateMN

VIII. Authorized Official

Name: MRS. ERYN STENNES
Title or Position: OFFICE MANAGER
Credential:
Phone: 952-888-5805