Healthcare Provider Details

I. General information

NPI: 1619008067
Provider Name (Legal Business Name): NESSETH CHIROPRACTIC CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BROADWAY AVE S
COKATO MN
55321-4681
US

IV. Provider business mailing address

PO BOX 818
COKATO MN
55321-0818
US

V. Phone/Fax

Practice location:
  • Phone: 320-286-6336
  • Fax: 320-286-6337
Mailing address:
  • Phone: 320-286-6336
  • Fax: 320-286-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID GENE NESSETH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 320-286-6336