Healthcare Provider Details

I. General information

NPI: 1205115912
Provider Name (Legal Business Name): PAUL D. DINGMAN PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3984 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421-3931
US

IV. Provider business mailing address

3984 CENTRAL AVE NE
COLUMBIA HEIGHTS MN
55421-3931
US

V. Phone/Fax

Practice location:
  • Phone: 763-788-9101
  • Fax: 763-789-4980
Mailing address:
  • Phone: 763-788-9101
  • Fax: 763-789-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number2701
License Number StateMN

VIII. Authorized Official

Name: DR. PAUL D DINGMAN
Title or Position: CHIROPRACTOR
Credential: PD
Phone: 763-788-9101