Healthcare Provider Details

I. General information

NPI: 1043361314
Provider Name (Legal Business Name): PATRICIA MICHELE CASELLO-MADDOX D.C., L..AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W 84TH ST
BLOOMINGTON MN
55431-1602
US

IV. Provider business mailing address

9820 DREW AVE S APT 209
BLOOMINGTON MN
55431-2768
US

V. Phone/Fax

Practice location:
  • Phone: 952-888-4777
  • Fax: 952-886-7561
Mailing address:
  • Phone: 651-592-7026
  • Fax: 952-886-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number003669
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1637
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: